Atezolizumab for locally advanced/metastatic urothelial carcinoma within the compassionate use program in Spain: The IMcompass study

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Background: Atezolizumab is a monoclonal antibody with proven efficacy in clinical trials for advanced or metastatic urothelial carcinoma (UC) after progression to platinum-based chemotherapy. Following EMA marketing authorization and before prizing and reimbursement was granted in Spain, the Spanish Medicines Agency authorized a compassionate use program. We describe the patient characteristics and atezolizumab effectiveness in this compassionate use program. Methods: It was a multicentre cohort study based on the retrospective chart review of patients with inoperable locally advanced or metastatic UC who received atezolizumab, following progression to platinum-based chemotherapy, under the compassionate use program in Spain. The primary endpoint was their demographic and clinical characterization. Secondary endpoints included the best response to atezolizumab, progression-free survival (PFS) and overall survival (OS). Results: 109 evaluable patients were included, with a median age (interquartile range, IQR) of 68.0 years (62.0-75.0), 87 males (79.8%) and 96 Caucasians (88.1%). Median age (IQR) at diagnosis was 64.0 years (58.0-72.0) and 92 (84.4%) had pure urothelial carcinoma. Twenty-four (22.0%) had received BCG, 18 (16.5%) neoadjuvant treatment, 19 (17.4%) adjuvant treatment, and 19 (17.4%) radiotherapy for primary tumour. Regarding prior metastatic treatments, 98 (89.9%) had received first-line chemotherapy, 46 (42.2%) second line, 19 (17.4%) third line, and 5 (4.6%) more lines. When starting atezolizumab, median age (IQR) was 69.0 years (62.0-74.0) and 105 (96.3%) had metastases: 71 (65.1%) in lymph nodes and 64 (58.7%) visceral (skeletal n = 31, lung n = 29, liver n = 26, other n = 13). Atezolizumab was used for a median (IQR) of 2.8 (1.4-8.4) months and 5.0 (3.0-13.0) administered doses. The overall response rate was 23.8%, with 6 patients (5.5%) achieving complete response and 20 (18.3%) partial response. Stable disease was observed in 21 (19.3%), progression in 44 (40.4%) and response was not evaluable in 18 (16.5%). The median PFS (95% CI) was 3.7 months (2.8-5.8), with PFS rates at months 3, 6, 9 and 12 of 57.5%, 38.0%, 30.5% and 26.1%, respectively. The median OS (95% CI) reached 8.5 (6.6-12.6) months, with a 12-month OS of 43.4%. Twenty-three patients (21.1%) reported 26 delays (adverse event n = 16, intercurrent event n = 10) and 2 (1.8%) interruptions (adverse event n = 1, intercurrent event n = 1). Atezolizumab was discontinued in 64 (58.7%) due to disease progression (n = 43, 67.2%), death (n = 13, 20.3%), adverse events (n = 7, 10.9%) and lost to follow-up (n = 1, 1.6%). Conclusions: This study provides real-world evidence on the characteristics of patients with advanced or metastatic UC treated with atezolizumab under the Spanish compassionate use program, supporting its effectiveness in the clinical setting.

SPAZO2 (SOGUG): Outcomes of patients treated with pazopanib as first line in mRC according to gender in real world

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Background: Treatment of mRC is not affected by gender, studying possible differences in a real-world study, could increase the knowledge of toxicity and possible prognostic factors. Methods: SPAZO2 (NCT03091465) was a retrospective real-world study to analyze the effectiveness of 1st-line pazopanib and subsequent therapies in mRC. Data from 530 pt treated outside CT were collected in 50 spanish centers, and externally monitored. Ineligibility criteria: ECOG > 1, pure nonclear-cell, Hgb < 9 g/dl, renal failure, severe cardiovascular disease, chronic liver disease, or recent neoplasia Results: 530 pt were included, 67.2% men (M), mean age was 66.2 years (26-92). There were no significant differences (M vs W) in the age > 75 (24.7 vs 24.1%), clear cell carcinoma (77.2 vs 79.9%), nephrectomy (72.5 vs 68.4%), IMDC (favourable: 15.2 vs 12.1%, intermediate: 59.3 vs 64.4%, poor: 25.6 vs 23.6%), metastases (lymph nodes: 46.1 vs 43.1%, lung: 69,7 vs 67,2 %, liver: 16 vs 20.1%, bone: 27 vs 24.1%, skin/soft tissues: 1.1 vs 3,4% and CNS: 4,8% vs 6.3%). Discontinuation due to toxicity or comorbidities was 12.4 vs 9.8%. There were no differences in the second lines received (57.9 vs 56.9%), neither response, PFS and OS (table). Median follow up was 39 mo. The gender has no prognostic value when adjusted for the prognostic groups of IMDC (HR of PFS 0.96, CI 95% 0.78-1.2, HR of OS: 0.92, CI 95% 0.72-1.14). Only diarrhea and elevation of uric acid were higher in the men group. Conclusions: Pazopanib was safe and effective in both groups with similar outcome. Women had less diarrhea and less increased uric acid. There were not differences in OS or PFS. In IMDC subgroup analysis, there is a trend towards a better evolution or PFS in the poor prognosis women subgroup. Clinical trial information: NCT03091465. [Table: see text]

Family history record and hereditary cancer risk perception after the creation of a heredofamilial cancer unit in a Spanish hospital

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Background: A comprehensive family history and consideration of the criteria for hereditary cancer risk are essential for oncology practice, since patients and relatives at risk could benefit from further genetic counseling (GC). The objective of this work is to compare the family history record and the hereditary cancer perception risk according to national cancer institute (NCI) criteria before and after the creation of a heredofamilial cancer unit (HFCU). Methods: We retrospectively analyze the clinical records from new incoming patients of our medical oncology service in two cohorts: Cohort 1, from January 2009 to December 2009 (before HFCU creation); and cohort 2, from May 2010 to August 2010 (first four months after HFCU creation). Family history record (yes/no) and NCI general hereditary cancer criteria (unusually early age; one or more first-degree relatives affected with the same or a related tumor; synchronous, bilateral or metachronous cancer in the same individual; atypical presentations; suggestive pathology report) were collected. Results were compared using chi-square test. p <0.05 was considered significant. Results: The table summarizes the results. In cohort 1, 28% (175/621) of clinical records contained the family history, while in cohort 2 this percentage increased to 54% (92/171), (p<0.001). 17% (106/621) patients in cohort 1 and 23% (40/171) in cohort 2, met NCI risk criteria (N.S.) In cohort 1, 13% (14/106) of these patients were referred to GC, while in cohort 2 this percentage increased to 38% (15/40) (p<0.01). Conclusions: The creation of a multidisciplinary HFCU significantly increased the quality of family history records and the referral of patients at risk to GC. However, the percentages still remain limited and further efforts must be made in order to remark the importance of family history in oncology. [Table: see text]

Low body weight is a risk factor for proteinuria in multiracial Southeast Asian pediatric population

We examined the impact of low birth weight and low current body weight on proteinuria in a cohort of children participating in the pilot study of a nationwide screening program. Two thousand eighty-three children underwent screening examinations, including birth history, anthropometric measures, blood pressure measurements, and urinalysis. On this study, children with proteinuria were found to have significantly lower mean body weights compared with children without proteinuria (38.7 +/- 7.6 versus 42.8 +/- 11.0 kg; P < 0.001). Progressively decreasing body weights were associated with increasing degrees of proteinuria (42.8 +/- 11.0, 38.9 +/- 7.6, and 37.2 +/- 8.5 kg for 0, 30, and 100 mg/dL of protein, respectively; P = 0.05). When examined by multiple logistic regression, low body weight was associated with a 1.8-fold greater risk (95% confidence interval, 1.27 to 2.64; P = 0.0019) for proteinuria after adjusting for potential confounders. There were trends for lower birth weights in children with proteinuria (3,047.6 +/- 445.2 versus 3,175.0 +/- 608.6 g for proteinuric and nonproteinuric groups, respectively; P = 0.275) and a greater prevalence of children with birth weights less than the 25th percentile (31.3% versus 25.0%; P = 0.786). The relationship between low current body weight and proteinuria was not explained by differences in blood pressure. In conclusion, low current body weight had a stronger relationship with proteinuria than low birth weight in this pediatric population. We hypothesize that the effect of low birth weight on renal disease may be significantly enhanced by environmental factors that result in a low current body weight.

Funding ESRD care through charity: the paradigm of the National Kidney Foundation of Singapore

Given the prohibitive costs of end-stage renal disease (ESRD) care for certain countries and the increasing incidence of ESRD worldwide, alternative methods of funding dialysis care are increasingly necessary. We describe the paradigm of the National Kidney Foundation of Singapore (NKF-S), the provider of subsidized dialysis care and comprehensive rehabilitative services to approximately 60% of all ESRD patients in the country, whose activities are funded entirely by charitable public donations. Unique to the NKF-S model are the considerations of the donor as an "investor" in the health care of NKF-S dialysis patients, the personal responsibility of the dialysis patient as a recipient of this "investment" to play an active role in achieving good clinical and rehabilitative outcomes, and the fostering of community-based support systems to facilitate patient rehabilitation such as partnerships with employers willing to employ dialysis patients. The success of the system is shown by its clinical outcomes, which approximate those observed in the United States. We believe that several aspects of the NKF-S model for ESRD care may be implemented in other communities, particularly in countries that have yet to develop financially and clinically mature dialysis programs.

Predictors for abnormal voiding cystourethrography in pediatric patients undergoing renal transplant evaluation

The role of pretransplant voiding cystourethrography (VCUG) in adults has been questioned owing to the low prevalence of abnormal findings. As there are no studies evaluating the relevance of VCUG in children and because vesicoureteral reflux (VUR) occurs with higher prevalence in children, we performed a retrospective cohort study to identify any predictors for abnormal VCUG. We reviewed 271 consecutive renal transplants performed between 1980 and 1997. By logistic regression, the etiology of end-stage renal disease (ESRD) and age at transplantation (Tx) were strong predictors of abnormal pretransplant VCUG findings in children. On multi-variate analysis, children with urologic etiologies of renal disease had an odds ratio (OR) of 16.5 (p < 0.0001) for abnormal VCUG as compared to children with non-urologic or acquired causes of ESRD. Similarly, children transplanted when younger than 8 yr of age had an OR of 3.0 (p = 0.0043) for having an abnormal VCUG when compared with older children. Finally, our analysis suggests that children with abnormal pretransplant VCUG findings, whether or not pretransplant surgical correction was performed, were over three-fold more likely to require post-transplant urologic surgery when compared to children with normal pretransplant VCUG. We conclude that urologic causes of ESRD and age under 8 yr are strong independent predictors of abnormal pretransplant VCUG findings, and that these findings are of clinical relevance both in deciding whether to pursue pretransplant VCUG and in the post-transplant course of the patient.