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Yu EM, Mudireddy M, Biswas R, Aragon-Ching JB. The role of switch maintenance therapy in urothelial cancers. Ther Adv Urol 2023; 15:17562872221147760. [PMID: 36891217 PMCID: PMC9986508 DOI: 10.1177/17562872221147760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 12/09/2022] [Indexed: 01/15/2023] Open
Abstract
Maintenance therapy with immune checkpoint inhibitors (ICIs) has changed the treatment paradigm of metastatic urothelial carcinoma (mUC). The JAVELIN Bladder 100 trial established avelumab, one of several ICIs in use today, as a life-prolonging maintenance therapy for patients with advanced urothelial carcinoma. Platinum-based chemotherapy is most often used in the first-line treatment of mUC, and while response rates approach about 50%, disease control is usually short-lived upon completion of the standard three to six cycles of chemotherapy. Much progress has been made in recent years in the second-line space and beyond with the use of ICIs, antibody-drug conjugates (ADCs), and tyrosine kinase inhibitors (TKIs) in eligible patients at the time of disease progression post-platinum-based chemotherapy. However, many patients with progressive mUC after first-line chemotherapy suffer from rapid progression of disease, treatment toxicity with subsequent lines of therapy, and a limited life expectancy. Until the results of the JAVELIN Bladder 100 trial were presented in 2020, there were no maintenance strategies proven to be beneficial over best supportive care after disease control is achieved with first-line platinum-based chemotherapy. To date, standard of care frontline treatment of metastatic urothelial cancer remains to be four to six cycles of platinum-based chemotherapy followed by maintenance avelumab. This review summarizes the current evidence available on maintenance therapies in mUC, as well as several highly anticipated clinical trials that we hope will result in further progress in the management of this aggressive cancer and improve patient outcomes.
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Affiliation(s)
- Eun-mi Yu
- GU Medical Oncology, Inova Schar Cancer
Institute, Fairfax, VA, USA
| | - Mythri Mudireddy
- Department of Hematology and Oncology, Inova
Schar Cancer Institute, Fairfax, VA, USA
| | - Rakesh Biswas
- Department of Hematology and Oncology, Inova
Schar Cancer Institute, Fairfax, VA, USA
| | - Jeanny B. Aragon-Ching
- GU Medical Oncology, Inova Schar Cancer
Institute, 8081 Innovation Park Drive, Fairfax, VA 22031, USA
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Rizzo A, Mollica V, Santoni M, Ricci AD, Gadaleta-Caldarola G, Montironi R, Massari F. Impact of clinicopathological features on immune-based combinations for advanced urothelial carcinoma: a meta-analysis. Future Oncol 2022; 18:739-748. [PMID: 35048736 DOI: 10.2217/fon-2021-0841] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Aims: Immune checkpoint inhibitors (ICIs) have recently revolutionized the treatment landscape of metastatic urothelial carcinoma. The authors performed a meta-analysis aiming to evaluate the predictive value of Eastern Cooperative Oncology Group performance status, age, sex, liver metastasis and histology in trials comparing first-line ICI-based combinations with chemotherapy in metastatic urothelial carcinoma patients. Methods: Hazard ratios were analyzed. Results: ICI-based combinations significantly decreased the risk of death in several clinicopathological subgroups, including patients with no liver metastases (hazard ratio: 0.84; 95% CI: 0.74-0.95) and those with an Eastern Cooperative Oncology Group performance status of 0 (hazard ratio: 0.84; 95% CI: 0.72-0.97). Conclusion: The benefit of ICI-based combinations over chemotherapy in metastatic urothelial carcinoma was consistent across several clinicopathological subgroups, although a proportion of patients responded to chemotherapy alone.
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Affiliation(s)
- Alessandro Rizzo
- Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero Universitaria di Bologna, Via Albertoni 15, Bologna, 70128, Italy.,Medical Oncology Unit, 'Mons. R. Dimiccoli' Hospital, Barletta, ASL BT (Barletta, Andria, Trani), 76121, Italy
| | - Veronica Mollica
- Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero Universitaria di Bologna, Via Albertoni 15, Bologna, 70128, Italy
| | - Matteo Santoni
- Medical Oncology Unit, Macerata General Hospital, Macerata, 62100, Italy
| | - Angela Dalia Ricci
- Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero Universitaria di Bologna, Via Albertoni 15, Bologna, 70128, Italy.,Medical Oncology Unit, 'Mons. R. Dimiccoli' Hospital, Barletta, ASL BT (Barletta, Andria, Trani), 76121, Italy
| | - Gennaro Gadaleta-Caldarola
- Medical Oncology Unit, 'Mons. R. Dimiccoli' Hospital, Barletta, ASL BT (Barletta, Andria, Trani), 76121, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, School of Medicine, Polytechnic University of the Marche Region, United Hospitals, Ancona, 60126, Italy
| | - Francesco Massari
- Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero Universitaria di Bologna, Via Albertoni 15, Bologna, 70128, Italy
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3
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Bersanelli M, Mazzaschi G, Giannatempo P, Raggi D, Farè E, Maruzzo M, Basso U, De Giorgi U, Vignani F, Banna GL, Stellato M, Tambaro R, Naglieri E, Losanno T, Procopio G, Pignata S, Necchi A, Buti S. Immunotherapy and Sonpavde score validation in advanced upper tract urothelial carcinoma: a retrospective study by the Italian Network for Research in Urologic-Oncology. Immunotherapy 2021; 14:107-114. [PMID: 34784782 DOI: 10.2217/imt-2021-0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Few data are available regarding the effectiveness of immune checkpoint inhibitors in advanced upper tract urothelial carcinoma (UTUC) patients. Methods: To provide a real-world experience with anti-PD-1/PD-L1-based therapy in UTUC patients, we involved an Italian network in a multicenter retrospective analysis. Results: A total of 78 UTUC patients were enrolled. The median follow-up was 25.1 months. The median progression-free survival (mPFS) was 2.2 months (95% CI 1.8-2.6), and the median OS (mOS) was 6.0 months (95% CI 3.6-8.4). The Sonpavde score (including performance status > 0, hemoglobin < 10 g/dl, liver metastases, time from prior chemotherapy ≥ 3 months) split the patients into three groups (0 vs 1 vs 2-4 factors), efficiently predicting the OS and PFS outcome at the multivariate analyses (p < 0.0001). Conclusion: The prognosis of unselected UTUC patients is still unsatisfactory. The Sonpavde score was validated for the first time in an UTUC population, as a useful tool for the treatment decision-making process.
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Affiliation(s)
- Melissa Bersanelli
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy.,Department of Medicine & Surgery, University of Parma, Parma, 43126, Italy
| | - Giulia Mazzaschi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy.,Department of Medicine & Surgery, University of Parma, Parma, 43126, Italy
| | - Patrizia Giannatempo
- Dipartimento di Oncologia Medica, Fondazione Istituto Nazionale Tumori, Milano, 20133, Italy
| | - Daniele Raggi
- Department of Urology, IRCCS San Raffaele Hospital, & Vita Salute San Raffaele University, Milano, 20132, Italy
| | - Elena Farè
- Dipartimento di Oncologia Medica, Fondazione Istituto Nazionale Tumori, Milano, 20133, Italy
| | - Marco Maruzzo
- Istituto Oncologico Veneto (IOV), Padova, 35128, Italy
| | - Umberto Basso
- Istituto Oncologico Veneto (IOV), Padova, 35128, Italy
| | - Ugo De Giorgi
- Medical Oncology, Scientific Institute of Romagna for the Study & Treatment of Tumors (IRST) IRCCS, Meldola, 47014, Italy
| | | | - Giuseppe Luigi Banna
- Medical Oncology, Cannizzaro Hospital, Catania, 95126, Italy.,Oncology Department, Portsmouth University Hospitals NHS Trust, Portsmouth, P06 3LY, UK
| | - Marco Stellato
- Medical Oncology Department, University Campus Biomedico, Roma, 00128, Italy
| | - Rosa Tambaro
- Department of Urology & Gynecology, UOC Oncologia Medica Uro-Ginecologica, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, 80131, Italy
| | - Emanuele Naglieri
- Department of Medical Oncology, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, 70124, Italy
| | - Tania Losanno
- Medical Oncology, San Camillo Forlanini Hospital, Roma, 00152, Italy
| | - Giuseppe Procopio
- Dipartimento di Oncologia Medica, Fondazione Istituto Nazionale Tumori, Milano, 20133, Italy
| | - Sandro Pignata
- Department of Urology & Gynecology, UOC Oncologia Medica Uro-Ginecologica, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, 80131, Italy
| | - Andrea Necchi
- Department of Urology, IRCCS San Raffaele Hospital, & Vita Salute San Raffaele University, Milano, 20132, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
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Stecca C, Abdeljalil O, Sridhar SS. Metastatic Urothelial Cancer: a rapidly changing treatment landscape. Ther Adv Med Oncol 2021; 13:17588359211047352. [PMID: 34616491 PMCID: PMC8488509 DOI: 10.1177/17588359211047352] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/01/2021] [Indexed: 12/20/2022] Open
Abstract
Despite significant progress, metastatic urothelial cancer remains an incurable condition with a limited life expectancy. Platinum-based chemotherapy is still the mainstay of treatment for metastatic disease, but immunotherapy, antibody drug conjugates, and targeted agents have shown encouraging results in several recent practice changing trials. In this review, we discuss the standard of care, recent therapeutic advances, ongoing clinical trials, and future perspectives in metastatic urothelial carcinoma.
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Affiliation(s)
- Carlos Stecca
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Osama Abdeljalil
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Srikala S. Sridhar
- Professor, University of Toronto, Medical Oncologist, Princess Margaret Cancer Center, Chair, GU Medical Oncologists of Canada, 7-625 -700 University Avenue, Toronto, ON M5G 2M9, Canada
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Kato M, Kobayashi T, Matsui Y, Ito K, Hikami K, Yamada T, Ogawa K, Nakamura K, Sassa N, Yokomizo A, Abe T, Tsuchihashi K, Tatarano S, Inokuchi J, Tomida R, Fujiwara M, Takahashi A, Matsumoto K, Shimizu K, Araki H, Kurahashi R, Ozaki Y, Tashiro Y, Uegaki M, Kojima T, Uchida J, Ogawa O, Nishiyama H, Kitamura H. Impact of the objective response to and number of cycles of platinum-based first-line chemotherapy for metastatic urothelial carcinoma on overall survival of patients treated with pembrolizumab. Int J Urol 2021; 28:1261-1267. [PMID: 34545627 DOI: 10.1111/iju.14686] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/18/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To investigate the impact of the number of cycles and objective response to chemotherapy on overall survival in patients with metastatic urothelial carcinoma treated with pembrolizumab. METHODS This multicenter, retrospective study included 755 patients from 59 institutions with advanced, chemoresistant urothelial carcinoma who received pembrolizumab. The associations of the overall survival with the number of cycles and best objective response were investigated using Cox multiple regression analysis. RESULTS Overall, 391 patients received standard first-line chemotherapy and pembrolizumab as a second-line treatment, and were included in the final analysis. Of the 391 patients, 185 received less than four cycles, 134 received four to six cycles and 72 received more than six cycles of first-line chemotherapy. An objective response (complete or partial response) to chemotherapy was observed in 145 patients (37.1%). Univariate analysis showed that the overall survival of patients who received more than six cycles or responded to chemotherapy (complete or partial response) was significantly longer than that of patients who received less than four cycles or did not respond to chemotherapy (stable or progressive disease). At multivariate levels, no correlations were observed between overall survival and the number of cycles of or the response to chemotherapy. CONCLUSIONS Therapeutic benefit of pembrolizumab can be expected irrespective of the objective response to and number of cycles of platinum-based first-line chemotherapy.
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Affiliation(s)
- Minoru Kato
- Department of Urology, Osaka City University, Osaka, Japan
| | - Takashi Kobayashi
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshiyuki Matsui
- Department of Urology, National Cancer Center Hospital, Tokyo, Japan
| | - Katsuhiro Ito
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Kensuke Hikami
- Department of Urology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Takeshi Yamada
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kosuke Ogawa
- Department of Urology, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Kenji Nakamura
- Department of Urology, Japanese Red Cross Osaka Hospital, Osaka, Japan
| | - Naoto Sassa
- Department of Urology, Aichi Medical University Hospital, Nagakute, Japan
| | - Akira Yokomizo
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | - Takashige Abe
- Department of Urology, Hokkaido University, Sapporo, Japan
| | | | | | | | - Ryotaro Tomida
- Department of Urology, Shikoku Cancer Center, Matsuyama, Japan
| | | | - Atsushi Takahashi
- Department of Urology, Hakodate Goryoukaku Hospital, Hakodate, Japan
| | | | - Kosuke Shimizu
- Department of Urology, Kyoto Katsura Hospital, Kyoto, Japan
| | - Hiromasa Araki
- Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | | | - Yu Ozaki
- Department of Urology, National Hospital Organization Himeji Medical Center, Himeji, Japan
| | - Yu Tashiro
- Department of Urology, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka, Japan
| | | | - Takahiro Kojima
- Department of Urology, University of Tsukuba, Tsukuba, Japan
| | - Junji Uchida
- Department of Urology, Osaka City University, Osaka, Japan
| | - Osamu Ogawa
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Rouanne M, Radulescu C, Adam J, Allory Y. PD-L1 testing in urothelial bladder cancer: essentials of clinical practice. World J Urol 2020; 39:1345-1355. [PMID: 33141317 DOI: 10.1007/s00345-020-03498-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/13/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE While immunotherapy has become an increasingly attractive strategy in patients with urothelial bladder cancer, the need for a biomarker to identify patients whose cancer is the most likely to respond has never been more crucial. This review systematically evaluates evidence regarding PD-L1 as a predictive biomarker of response to anti-PD(L)1 monoclonal antibodies in patients with urothelial bladder carcinoma, and discusses its current limits in routine clinical practice. METHODS We performed a critical review of PubMed/Medline according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement. Prospective clinical trials evaluating anti-PD(L)1 monoclonal antibodies in urothelial bladder carcinoma together with retrospective studies evaluating PD-L1 expression in patients with bladder cancer were included. RESULTS Evidence data related to PD-L1 as a predictive biomarker of response to immune checkpoint blockade monotherapy across clinical trials are detailed in this review. The different companion diagnostic assays, and the methods for PD-L1 scoring in urothelial bladder carcinoma are reported. Additionally, the issues related to the implementation of PD-L1 testing in clinical practice are discussed. CONCLUSIONS PD-(L)1 monoclonal antibodies atezolizumab and pembrolizumab are restricted to patients with PD-L1 positive status in the first-line setting in patients with advanced or metastatic urothelial bladder carcinoma who are ineligible to cisplatin-based chemotherapy. Importantly, the use of anti-PD(L)1 mAb in the other clinical settings is not based on PD-L1 status, but rather on patients' clinical characteristics. Further identification of biomarkers with high negative predictive value will also be of utmost importance to identify patients who may not respond to such immunotherapies.
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Affiliation(s)
- Mathieu Rouanne
- Département d'Urologie, Université Versailles-Saint-Quentin-en-Yvelines, Université Paris-Saclay, Hôpital FOCH, 40, rue Worth, 92150, Suresnes, France.
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1015, Equipe Labellisée Ligue Nationale Contre le Cancer, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France.
| | - Camélia Radulescu
- Département de Pathologie, Hôpital Foch, UVSQ, Université Paris-Saclay, 92150, Suresnes, France
| | - Julien Adam
- Département de Pathologie, Hôpital Paris Saint-Joseph, 75014, Paris, France
- INSERM U1186, Gustave Roussy, 94805, Villejuif, France
| | - Yves Allory
- Département de Pathologie, Hôpital Foch, UVSQ, Université Paris-Saclay, 92150, Suresnes, France
- Départment de Pathologie, Institut Curie, 92210, Saint-Cloud, France
- Centre National de la Recherche Scientifique (CNRS) UMR144, Equipe Labellisée Ligue Nationale Contre le Cancer, 75005, Paris, France
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