免疫檢查點抑制劑在轉移性泌尿道上皮癌併末期腎病變病患之應用
黃英哲1 、康智雄1、羅浩倫1 、蘇祐立2、 江博暉1
1高雄長庚紀念醫院外科部泌尿科，2血液腫瘤科
Immune checkpoint inhibitors (ICIs) in end-stage renal disease (ESRD) patients with metastatic urothelial carcinoma (mUC)
Ying-Che, Huang1、Chih-Hsiung Kang1、Hao-Lun Luo1、Yu-Li Su2、Po-Hui Chiang1
1Divisions of Urology, Department of Surgery and 2Department of Oncology, Kaohsiung Chang Gung Memorial Hospital
Purpose: Currently, immune checkpoint inhibitors (ICIs) are used as first or second-line therapy of metastatic urothelial carcinoma (mUC). However, the data of ICIs in patients with end-stage renal disease (ESRD) is limited. Here, we described our experience of 11 ESRD cases with mUC treated with ICIs.
Material and methods: We performed a retrospective review on the treatment of mUC in ESRD patients at our institution between April 2016 and November 2019. Among these 11 patients, 7 received ICIs alone and 4 received ICIs and systemic chemotherapy. The primary outcome was overall survival (OS). Adverse effects (AEs) were evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 grading system.
Results: Mean age was 64 years old. The primary site was renal pelvis in 6 patients, ureter in 1 patient, bladder in 2 patients and multiple organs in 2 patients (renal pelvis and ureter; renal pelvis and bladder). 6 of them (54%) achieved a partial response and 1 of them (9%) had stable disease. 3 patients died due to mUC. AEs of all grades included hematologic toxicity (neutropenia 54.5%; anemia 100%; and thrombocytopenia 72%), hepatitis (27.3%), fatigue (18.2%), anorexia (27.3%), and dermatologic toxicity (18.2%). All patients experienced at least one treatment-related AE and 7 of them (63.6%) had high grade (grade ≥ 3) AEs. Hematologic toxicity is the most common AE. Among the 6 patients had high-grade hematologic AEs, 4 received ICIs and systemic chemotherapy.
Conclusions: In our study, about one-half of patients have a partial or complete response. Administration of ICIs in patients with mUC and ESRD is feasible with an acceptable toxicity profile. Combination with systemic chemotherapy had higher grade AEs, especially in hematologic side effects.