台中榮民總醫院 外科部 泌尿科
Immunotherapy with Checkpoint Inhibitors Improves Survival in Patients with Metastatic Urothelial Carcinoma
Peng-Yen Wu, Jain-Ri Li, Kun-Yuan Chiu, Shian-Shiang Wang, Cheng-Kuang Yang, Chuan-Shu Chen, Kevin Lu, Cheng-Che Chen, Shu-Chi Wang, Chia-Yen Lin, Sheng-Chun Hung
Division of Urology, Department of Surgery, Taichung Veterans General Hospital
Purpose: The platinum-based chemotherapy has been standard treatment for metastatic urothelial carcinoma (mUC) for decades. With better understanding of cancer immunology, the immunotherapies with checkpoint inhibitors (CPIs) has been clinically used as systemic treatment for patients with mUC. In this study, we compared the outcome of mUC patients who received systemic therapy with PCIs or chemotherapy only.
Materials and Methods: The patients with mUC, who received systemic therapy, either with checkpoint inhibitor (which could be atezolizumab, pembrolizumab, or durvalumab in our study, with or without combined chemotherapy/immunotherapy) or with chemotherapy only, were included. The patient characteristics and outcomes were recorded and analyzed.
Results: Between January, 2015 and October, 2020, 156 patients with mUC were retrospectively reviewed, including 94 patients treated with CPIs (with or without combined therapy) and 62 patients who received chemotherapy only. The patient characteristics were analyzed and showed poorer conditions in the group with chemotherapy, including lower hemoglobin level, more proportion with chronic kidney disease and liver metastasis, and poorer ECOG. Of all the 156 patients, the median overall survival (median OS) was 11.5 months, and the 5-year survival rate was 14.33%. The median overall survival was 28.4 months in the CPI group, as compared to 3.7 months in the chemotherapy group (p of log rank < 0.001). The 5-year survival rate for CPI and chemotherapy groups were 24.27% and 1.79%, respectively.
Conclusions: the checkpoint inhibitors improved the survival rate in patients with mUC. Nevertheless, the outcome could be influenced by patient selection bias, since our statistics showed better conditions among patients in the CPI group. Most patients in the CPI group were recruited by the clinical trials (63.8%), and this patient distribution could contribute to the selection bias. Further prospective studies are needed to improve the treatment strategy.