免疫檢查點抑制劑於治療轉移性尿路上皮癌患者之實際經驗

謝享宸、李建儀、裘坤元

台中榮民總醫院 外科部 泌尿外科

Real world experience of metastatic urothelial carcinoma treated with immune check point inhibitors

Hsiang-Chen Hsieh, Jian-Ri Li, Kun-Yuan Chiu

Taichung Veterans General Hospital, Division of Urology, Department of Surgery, Taichung.

Purpose:

Immune checkpoint inhibitors (ICIs) have become important tools for the treatment of metastatic urothelial carcinoma (mUC). Herein 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 and pembrolizumab were included in this retrospective study. The study was reviewed and approved by the Institute of Review Board. Among them, 53 patients received atezolizumab and the other 21 received pembrolizumab.

Results:

Ten patients (10/62, 16.12%) received carboplatin chemotherapy and the other 52 received cisplatin based chemotherapy. The basic characteristics were listed at 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, table 2). For further analysis of association of ICIs responses, only ICIs treatment duration was associated with better response (OR=1.08, 95% CI=1.01-1.16, p=0.025). However, high Neutrophil/Lymphocyte ratio (NLR) was associated with poor ICIs treatment response (OR=0.97, 95% CI=0.95-0.996, p=0.018).

Conclusions:

Our real world data showed ICIs was effective in the treatment of mUC patients. Chemotherapy also had an impact on the patient survival. Serum WBC or NLR may account for an indicator as poor outcome or poor responders for ICIs treatment.