免疫檢查哨抑制劑治療轉移性尿路上皮癌
陳柏諺、羅浩倫、蘇佑立、江博暉
高雄長庚紀念醫院 泌尿科 血液腫瘤科
The experiences of immune checkpoint inhibitor in the treatment of metastatic urothelial carcinoma
Po Yen Chen, Hao Lun Lo, Yu Li Su, Po Hui Chiang
Department of Urology, Department of Oncology, Kaohsiung Chang Gung Memorial Hospital
Purpose: To present the oncological outcomes of the immune checkpoint inhibitor for the patients with metastatic urothelial carcinoma.
Materials and Methods: We retrospectively reviewed patients who were diagnosed of metastatic urothelial carcinoma under immune checkpoint inhibitor therapy since 2016 to 2018. We classified patients into three categories: 1.immunotherapy as first-line, 2.chemotherapy as first-line, 3. simultaneous immunotherapy and chemotherapy. The parameters such as age, gender, clinical stage, pathological grade, tumor location (upper tract or bladder), pathological features, PD-L1 expression and image progression status were reviewed. The primary endpoint is objective response rate (ORR).
Results: 20 patients were included in our cohort with median follow-up 12.6 months. 12 of 20 patient showed partial or complete response (ORR=60%). Among the patients, 5 patients (25%) have complete response of the disease. The objective response rates for immunotherapy as the first-line, chemotherapy as first-line, and simultaneous immunotherapy and chemotherapy were 75%, 50%, 50%, respectively. There were no significant difference regarding to PDL-1 expression (p=0.373) and tumor location (p=0.648). Immune-related adverse events are minimal and tolerable for most patients. However, two patients underwent hypothyroidism episode and one patient underwent myasthenia gravis.
Conclusion: Immune checkpoint inhibitor therapy in metastatic urothelial carcinoma is a novel and effective therapy. The sequencing of immunotherapy and chemotherapy is important to maximize the outcome.