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Kobayashi K, Sakano S, Matsumoto H, Yamamoto M, Tsuchida M, Tei Y, Nagao K, Oba K, Kitahara S, Yano S, Yoshihiro S, Yamamoto Y, Ohmi C, Komatsu H, Misumi T, Akao J, Shiraishi K. Prognostic risk score and index including the platelet-to-lymphocyte ratio and lactate dehydrogenase in patients with metastatic or unresectable urothelial carcinoma treated with immune checkpoint inhibitors. Jpn J Clin Oncol 2024:hyae137. [PMID: 39373462 DOI: 10.1093/jjco/hyae137] [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: 08/20/2024] [Accepted: 09/20/2024] [Indexed: 10/08/2024] Open
Abstract
BACKGROUND Avelumab and pembrolizumab are administered after platinum-based chemotherapy for the treatment of metastatic urothelial carcinoma. We explored the prognostic factors and risk scores for predicting the outcomes of metastatic or unresectable urothelial carcinoma at the start of treatment with immune checkpoint inhibitors. METHODS This retrospective study included patients with metastatic or unresectable urothelial carcinoma treated with avelumab or pembrolizumab after platinum-based chemotherapy between January 2017 and December 2022. Prognostic factors, including patient and tumor characteristics and blood data at the initiation of immune checkpoint inhibitor therapy, were examined. RESULTS This study included 36 and 207 patients treated with avelumab and pembrolizumab, respectively, for metastatic or unresectable urothelial carcinoma. Eastern Cooperative Oncology Group performance status, presence of visceral metastases, platelet-to-lymphocyte ratio and lactate dehydrogenase levels were independent prognostic factors for predicting overall survival. The median overall survival of patients in the risk-score model was 58.5 months (score zero), 27.9 months (one), 13.1 months (two) and 3.9 months (three or higher). The C-index for overall survival was 0.718 for the newly developed risk score compared with 0.679 for the Bellmunt score and 0.703 for the Bellmunt-C-reactive protein score. Additionally, the C-index for overall survival using the immune prognostic index derived from lactate dehydrogenase and the platelet-to-lymphocyte ratio was 0.646 compared with 0.615 for the Lung Immune Prognostic Index. CONCLUSIONS A risk score that includes the platelet-to-lymphocyte ratio and lactate dehydrogenase may serve as a useful model for predicting prognosis following the initiation of immune checkpoint inhibitors in patients with metastatic or unresectable urothelial carcinoma.
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Affiliation(s)
- Keita Kobayashi
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Shigeru Sakano
- Department of Urology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroaki Matsumoto
- Department of Urology, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
| | - Mitsutaka Yamamoto
- Department of Urology, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
| | - Masahiro Tsuchida
- Department of Urology and Nephrology, Tokuyama Central Hospital, Shunan, Japan
| | - Yasuhide Tei
- Department of Urology, Kanmon Medical Center, Shimonoseki, Japan
| | - Kazuhiro Nagao
- Department of Urology, Shuto General Hospital, Yanai, Japan
| | - Kazuo Oba
- Department of Urology, Saiseikai Yamaguchi General Hospital, Yamaguchi, Japan
| | - Seiji Kitahara
- Department of Urology, Nagato General Hospital, Nagato, Japan
| | - Seiji Yano
- Department of Urology, Masuda Red Cross Hospital, Masuda, Japan
| | - Satoru Yoshihiro
- Department of Urology, Shimonoseki City Hospital, Shimonoseki, Japan
| | - Yoshiaki Yamamoto
- Department of Urology, Sanyo-Onoda Municipal Hospital, Sanyo-Onoda, Japan
| | - Chietaka Ohmi
- Department of Urology, Ube-kohsan Central Hospital Corp, Ube, Japan
| | - Hirotaka Komatsu
- Department of Urology, Shimonoseki Saiseikai Toyoura Hospital, Shimonoseki, Japan
| | - Taku Misumi
- Department of Urology, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - Jumpei Akao
- Department of Urology, Hikari Municipal Hikari General Hospital, Hikari, Japan
| | - Koji Shiraishi
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
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Taguchi S, Kawai T, Nakagawa T, Kume H. Latest evidence on clinical outcomes and prognostic factors of advanced urothelial carcinoma in the era of immune checkpoint inhibitors: a narrative review. Jpn J Clin Oncol 2024; 54:254-264. [PMID: 38109484 DOI: 10.1093/jjco/hyad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/25/2023] [Indexed: 12/20/2023] Open
Abstract
The management of advanced (locally advanced or metastatic) urothelial carcinoma has been revolutionized since pembrolizumab was introduced in 2017. Several prognostic factors for advanced urothelial carcinoma treated with pembrolizumab have been reported, including conventional parameters such as performance status and visceral (especially liver) metastasis, laboratory markers such as the neutrophil-to-lymphocyte ratio, sarcopenia, histological/genomic markers such as programmed cell death ligand 1 immunohistochemistry and tumor mutational burden, variant histology, immune-related adverse events, concomitant medications in relation to the gut microbiome, primary tumor site (bladder cancer versus upper tract urothelial carcinoma) and history/combination of radiotherapy. The survival time of advanced urothelial carcinoma has been significantly prolonged (or 'doubled' from 1 to 2 years) after the advent of pembrolizumab, which will be further improved with novel agents such as avelumab and enfortumab vedotin. This review summarizes the latest evidence on clinical outcomes and prognostic factors of advanced urothelial carcinoma in the contemporary era of immune checkpoint inhibitors.
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Affiliation(s)
- Satoru Taguchi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Tohru Nakagawa
- Department of Urology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Seban RD, Arnaud E, Loirat D, Cabel L, Cottu P, Djerroudi L, Hescot S, Loap P, Bonneau C, Bidard FC, Huchet V, Jehanno N, Berenbaum A, Champion L, Buvat I. [18F]FDG PET/CT for predicting triple-negative breast cancer outcomes after neoadjuvant chemotherapy with or without pembrolizumab. Eur J Nucl Med Mol Imaging 2023; 50:4024-4035. [PMID: 37606858 DOI: 10.1007/s00259-023-06394-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE To determine if pretreatment [18F]FDG PET/CT could contribute to predicting complete pathological complete response (pCR) in patients with early-stage triple-negative breast cancer (TNBC) undergoing neoadjuvant chemotherapy with or without pembrolizumab. METHODS In this retrospective bicentric study, we included TNBC patients who underwent [18F]FDG PET/CT before neoadjuvant chemotherapy (NAC) or chemo-immunotherapy (NACI) between March 2017 and August 2022. Clinical, biological, and pathological data were collected. Tumor SUVmax and total metabolic tumor volume (TMTV) were measured from the PET images. Cut-off values were determined using ROC curves and a multivariable model was developed using logistic regression to predict pCR. RESULTS N = 191 patients were included. pCR rates were 53 and 70% in patients treated with NAC (N = 91) and NACI (N = 100), respectively (p < 0.01). In univariable analysis, high Ki67, high tumor SUVmax (> 12.3), and low TMTV (≤ 3.0 cm3) were predictors of pCR in the NAC cohort while tumor staging classification (< T3), BRCA1/2 germline mutation, high tumor SUVmax (> 17.2), and low TMTV (≤ 7.3 cm3) correlated with pCR in the NACI cohort. In multivariable analysis, only high tumor SUVmax (NAC: OR 8.8, p < 0.01; NACI: OR 3.7, p = 0.02) and low TMTV (NAC: OR 6.6, p < 0.01; NACI: OR 3.5, p = 0.03) were independent factors for pCR in both cohorts, albeit at different thresholds. CONCLUSION High tumor metabolism (SUVmax) and low tumor burden (TMTV) could predict pCR after NAC regardless of the addition of pembrolizumab. Further studies are warranted to validate such findings and determine how these biomarkers could be used to guide neoadjuvant therapy in TNBC patients.
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Affiliation(s)
- Romain-David Seban
- Department of Nuclear Medicine and Endocrine Oncology, Institut Curie, 92210, Saint-Cloud, France.
- Laboratoire d'Imagerie Translationnelle en Oncologie, Inserm U1288, Institut Curie, PSL University, Paris Saclay University, 91400, Orsay, France.
| | - Emilie Arnaud
- Department of Medical Oncology, Institut Curie, PSL Research University, 75005, Paris, France
| | - Delphine Loirat
- Department of Medical Oncology, Institut Curie, PSL Research University, 75005, Paris, France
| | - Luc Cabel
- Department of Medical Oncology, Institut Curie, PSL Research University, 75005, Paris, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie, PSL Research University, 75005, Paris, France
| | | | - Segolene Hescot
- Department of Nuclear Medicine and Endocrine Oncology, Institut Curie, 92210, Saint-Cloud, France
| | - Pierre Loap
- Department of Radiation Oncology, Institut Curie, 92210, Saint-Cloud, France
| | - Claire Bonneau
- Inserm U900, Institut Curie, 35, rue Dailly, 92210, Saint-Cloud, France
- Department of Surgery, Institut Curie, 92210, Saint-Cloud, France
| | - Francois-Clement Bidard
- Department of Medical Oncology, Institut Curie, UVSQ/Paris-Saclay University, 92210, Saint-Cloud, France
- Circulating Tumor Biomarkers Laboratory, Institut Curie, SiRIC, PSL Research University, Paris, France
| | - Virginie Huchet
- Department of Nuclear Medicine, Institut Curie, 75005, Paris, France
| | - Nina Jehanno
- Department of Nuclear Medicine, Institut Curie, 75005, Paris, France
| | - Arnaud Berenbaum
- Department of Nuclear Medicine and Endocrine Oncology, Institut Curie, 92210, Saint-Cloud, France
| | - Laurence Champion
- Department of Nuclear Medicine and Endocrine Oncology, Institut Curie, 92210, Saint-Cloud, France
- Laboratoire d'Imagerie Translationnelle en Oncologie, Inserm U1288, Institut Curie, PSL University, Paris Saclay University, 91400, Orsay, France
| | - Irene Buvat
- Laboratoire d'Imagerie Translationnelle en Oncologie, Inserm U1288, Institut Curie, PSL University, Paris Saclay University, 91400, Orsay, France
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Ando K, Kurashina R, Motoi N, Iizuka T, Inoue M, Maruyama R, Mitani K, Takenobu H, Haruta M, Onuki R, Matsuoka Y, Kamijo T, Kageyama Y. Positive regulatory loop of platelet-derived growth factor DD-induced STAT3 activation is associated with poor prognosis in advanced urothelial carcinoma. Biochem Biophys Res Commun 2023; 676:165-170. [PMID: 37517219 DOI: 10.1016/j.bbrc.2023.07.054] [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: 07/06/2023] [Revised: 07/12/2023] [Accepted: 07/21/2023] [Indexed: 08/01/2023]
Abstract
Immune checkpoint inhibitor (ICI) therapy has been established for patients with advanced urothelial cancer (UC). The necessity of overcoming resistance to ICIs and identifying a predictive factor for the same has been highlighted, such as the assessment of combination therapy with other targeted drugs and the characterization of molecular signatures in the tumor microenvironment. Recently, we reported that low hemoglobin (Hb) levels and a high platelet-to-lymphocyte ratio (PLR) were significantly associated with overall survival in patients with UC who did not benefit from pembrolizumab treatment. In the present study, we identified a possible link between these unfavorable prognostic indicators and PDGF-DD-induced STAT3 activation in UC. Overlapping patients between the high STAT3- or phosphorylated STAT3-positive score group (as assessed by immunohistochemistry) and low Hb levels or high PLR group (as assessed by blood tests) showed significantly worse outcomes after pembrolizumab treatment. Additionally, using the bladder cancer JMSU1 cell line, we demonstrated a possible positive regulatory loop between autocrine/paracrine PDGF-DD and STAT3 signaling. Therefore, we suggest that STAT3 inhibition and PDGF-DD detection in the tumor microenvironment might represent a potential therapeutic strategy to overcome resistance to pembrolizumab. Moreover, this can help identify patients with UC who could benefit from combination treatment.
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Affiliation(s)
- Kiyohiro Ando
- Research Institute for Clinical Oncology, Saitama Cancer Center, 818 Komuro, Ina, Kita-adachigun, Saitama, 362-0806, Japan.
| | - Ryo Kurashina
- Department of Urology, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachigun, Saitama, 362-0806, Japan
| | - Noriko Motoi
- Department of Pathology, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachigun, Saitama, 362-0806, Japan
| | - Toshihiko Iizuka
- Department of Pathology, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachigun, Saitama, 362-0806, Japan
| | - Masaharu Inoue
- Department of Urology, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachigun, Saitama, 362-0806, Japan
| | - Riko Maruyama
- Department of Urology, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachigun, Saitama, 362-0806, Japan
| | - Kouki Mitani
- Department of Urology, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachigun, Saitama, 362-0806, Japan
| | - Hisanori Takenobu
- Research Institute for Clinical Oncology, Saitama Cancer Center, 818 Komuro, Ina, Kita-adachigun, Saitama, 362-0806, Japan
| | - Masayuki Haruta
- Research Institute for Clinical Oncology, Saitama Cancer Center, 818 Komuro, Ina, Kita-adachigun, Saitama, 362-0806, Japan
| | - Ritsuko Onuki
- Research Institute for Clinical Oncology, Saitama Cancer Center, 818 Komuro, Ina, Kita-adachigun, Saitama, 362-0806, Japan
| | - Yoh Matsuoka
- Department of Urology, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachigun, Saitama, 362-0806, Japan
| | - Takehiko Kamijo
- Research Institute for Clinical Oncology, Saitama Cancer Center, 818 Komuro, Ina, Kita-adachigun, Saitama, 362-0806, Japan
| | - Yukio Kageyama
- Department of Urology, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachigun, Saitama, 362-0806, Japan
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