使用免疫檢查點抑制劑之癌症免疫療法治療轉移性泌尿上皮癌患者之結果

Metastatic urothelial carcinoma patients treated with immune checkpoint inhibitor based immunotherapy

陳韋辰¹、李建儀¹、裘坤元¹

¹臺中榮民總醫院外科部 泌尿科

Wei-Cheng, Chen¹, Jian‐Ri Lee¹, Kun-Yuan Chiu¹

Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital

Purpose: In the past threee decades, treatment for urothelial carcinoma has made great progrssion. We are now in the era of immunotherapy. Many international trials has enrolled patients with metastatic urothelial carcinoma (mUC) to evaluate the treatment outcomes. We now share the experience in mUC in a single center.

Materials and Methods: Between January, 2015 and October, 2020. There were 74 patients with metastatic urothelial carcinoma receiving Check Point Inhibitor (CPI) treatment in our institute. 38 of them received first line CPI together with chemotherapy, 12 patients were treated with first line CPI only, the other 24 failed in first chemotherapy, and accepted CPI as second line systemic treatment. We analyzed the demographic datas, past history, disease characteristic, the regimens they received, lab datas, treatment durations and survival status.

Results: Median overall survival of 74 patients was 28.44 months, and median progression free survival was 10.94 months. There were no statistical differences among three groups in progression free survival and overall survival. However, the first-line CPI combine with chemotherapy group has the highest percentage of survival, 38.49% in 5 years. Multivariate analysis showed better CPI response and longer chemothrapy duration decreased risk of death ( HR=0.22, CI=0.08-0.62, p=0.004; HR=0.91, CI= 0.86-0.97, p=0.003, respectively ), while the patients with liver metastasis and higher WBC count before CPI has decreased overall survival. Moreover, longer CPI duration improved CPI response, while patients with higher neutrophil/ lymphocyte ratio has decreased CPI response. Patients treatment with first-line combination therapy with CPI and chemotherapy have 2.17 times chance to incease CPI response than second line CPI therapy.

Conclusions: Among the metastatic urothelial carcinoma patients treated with immune checkpoint inhibitor, first-line combination therapy with immune checkpoint inhibitor and chemotherapy has longer and better overall survival than first-line CPI monotherapy and second-line CPI therapy group.