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Uchimoto T, Fukushima T, Komura K, Fukuokaya W, Adachi T, Hashimoto T, Yoshizawa A, Nakamura K, Yano Y, Nishimura K, Nishio K, Nakamori K, Iwatani K, Yamamoto S, Urabe F, Mori K, Yanagisawa T, Tsuduki S, Takahara K, Inamoto T, Miki J, Kimura T, Ohno Y, Shiroki R, Egawa S, Azuma H. Re-challenging chemotherapy after pembrolizumab in platinum-refractory urothelial carcinoma. BJU Int 2023; 131:477-485. [PMID: 36098556 DOI: 10.1111/bju.15893] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the real-world clinical benefit of re-challenging chemotherapy after pembrolizumab in patients with metastatic urothelial carcinoma (mUC), as there have been several reports suggesting that programmed cell death protein-1/programmed death-ligand 1inhibitors can restore platinum sensitivity. PATIENTS AND METHODS Of 236 patients treated with pembrolizumab, we excluded 45 patients who did not experience progressive disease (PD) for pembrolizumab during the follow-up and 86 patients who discontinued pembrolizumab by the diagnosis of PD followed by the best supportive care. A total of 105 patients were identified for a logistic regression propensity score model to compare the survival outcomes between patients treated with continuing pembrolizumab (80) and re-challenging chemotherapy (25) after the diagnosis of PD for pembrolizumab. RESULTS A median overall survival (OS) from PD for pembrolizumab was 11 months in 105 patients. Of 25 patients treated with re-challenging chemotherapy, platinum-including chemotherapy (gemcitabine and cisplatin; gemcitabine/cisplatin/paclitaxel [GCP]; methotrexate and vinblastine and adriamycin and cisplatin; and methotrexate and carboplatin and vinblastine MCAVI) was offered in 20 patients (80%). The objective response rate (ORR) for the first-line chemotherapy in the 105 patients was 30%, with a comparable ORR in 25 patients treated with re-challenging chemotherapy of 28%. GCP as a re-challenging regimen was offered in 12 of 25 (48%) patients. The ORR for the GCP regimen was 50%. Propensity score matching was performed using putative clinical factors, from which 34 patients were identified as pair-matched groups. The OS for patients treated with re-challenging chemotherapy was significantly longer than continuing pembrolizumab (a median of 13.9 and 5.8 months, respectively: P = 0.048). CONCLUSION Re-challenging chemotherapy including platinum agents after PD with pembrolizumab offers clinical benefits in patients with mUC.
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Affiliation(s)
- Taizo Uchimoto
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Tatsuo Fukushima
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Kazumasa Komura
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Wataru Fukuokaya
- Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Takahiro Adachi
- Department of Urology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Takeshi Hashimoto
- Department of Urology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Atsuhiko Yoshizawa
- Department of Urology, Fujita-Health University School of Medicine, Toyoake City, Aichi, Japan
| | - Ko Nakamura
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Yusuke Yano
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Kazuki Nishimura
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Kyosuke Nishio
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Keita Nakamori
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Shutaro Yamamoto
- Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Keiichiro Mori
- Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Shunsuke Tsuduki
- Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Kiyoshi Takahara
- Department of Urology, Fujita-Health University School of Medicine, Toyoake City, Aichi, Japan
| | - Teruo Inamoto
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Yoshio Ohno
- Department of Urology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita-Health University School of Medicine, Toyoake City, Aichi, Japan
| | - Shin Egawa
- Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Haruhito Azuma
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
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