Efficacy of Immune Check Point Inhibitors in Metastatic Urothelial Carcinoma is Associated with Chemotherapy Response, A Real World Retrospective Study
Wei-Cheng Chen, Jian-Ri Li, Kun-Yuan Chiu
Department of Urology, Taichung Veteran General Hospital, Taichung, Taiwan
Purpose: Immune checkpoint inhibitors (ICIs) is important in treating metastatic urothelial carcinoma (mUC). Beyond the second line post chemotherapy and the avelumab maintenance therapy which was proven effective, ICIs were also used in first line combinations or monotherapy in real world practice. We presented our single institute experience using ICIs in mUC patients.
Materials and Methods: Between January 2015 and October 2020, 74 mUC patients treated with atezolizumab (53 patients) and pembrolizumab (21 patients) were included. The study was reviewed and approved by the Institute of Review Board. We performed analysis of progression free survival, overall survival and the variant analysis.
Results: 50 patients received first line ICIs therapy and the other 24 received second line monotherapy. 10 patients (10/62, 16.12%) received carboplatin chemotherapy and the other 52 received cisplatin based chemotherapy. The basic characteristics were listed in table 1. The median age was 67 years old. The median treatment cycles of ICIs and chemotherapy were 6 and 4 respectively. The median ICIs and chemotherapy duration of treatment were 7.24 and 7.79 months respectively. The median progression free survival was 10.94 months and the overall survival was 28.44 months. ICIs response and chemotherapy duration were associated with decreased death risk (HR=0.22, 95% CI=0.08-0.62, p=0.004 and HR=0.91, 95% CI=0.86-0.91, p=0.003 respectively). Liver metastases and serum white blood cell count(WBC) before ICIs treatment were associated with increased risk of death (HR=11.95, 95% CI=3.22-44.34, p<0.001 and HR=1.0001, 95% CI=1.0001-1.0002, p=0.036 respectively). Furthermore, chemotherapy response and duration were associated with better ICIs response (OR=10.73, 95% CI=1.23-93.5, p=0.032; OR=1.13, 95% CI=1.04-1.24, p=0.007).
Conclusions: ICIs was effective in treating mUC patients. Chemotherapy response was associated with ICIs treatment efficacy.