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Bamias A, Merseburger A, Loriot Y, James N, Choy E, Castellano D, Lopez-Rios F, Calabrò F, Kramer M, de Velasco G, Zakopoulou R, Tzannis K, Sternberg CN. New prognostic model in patients with advanced urothelial carcinoma treated with second-line immune checkpoint inhibitors. J Immunother Cancer 2023; 11:jitc-2022-005977. [PMID: 36627145 PMCID: PMC9835946 DOI: 10.1136/jitc-2022-005977] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Bellmunt Risk Score, based on Eastern Cooperative Oncology Group (ECOG) performance status (PS), hemoglobin levels and presence of liver metastases, is the most established prognostic algorithm for patients with advanced urothelial cancer (aUC) progressing after platinum-based chemotherapy. Nevertheless, existing algorithms may not be sufficient following the introduction of immunotherapy. Our aim was to develop an improved prognostic model in patients receiving second-line atezolizumab for aUC. METHODS Patients with aUC progressing after cisplatin/carboplatin-based chemotherapy and enrolled in the prospective, single-arm, phase IIIb SAUL study were included in this analysis. Patients were treated with 3-weekly atezolizumab 1200 mg intravenously. The development and internal validation of a prognostic model for overall survival (OS) was performed using Cox regression analyses, bootstrapping methods and calibration. RESULTS In 936 patients, ECOG PS, alkaline phosphatase, hemoglobin, neutrophil-to-lymphocyte ratio, liver metastases, bone metastases and time from last chemotherapy were identified as independent prognostic factors. In a 4-tier model, median OS for patients with 0-1, 2, 3-4 and 5-7 risk factors was 18.6, 10.4, 4.8 and 2.1 months, respectively. Compared with Bellmunt Risk Score, this model provided enhanced prognostic separation, with a c-index of 0.725 vs 0.685 and increment in c-statistic of 0.04 (p<0.001). Inclusion of PD-L1 expression did not improve the model. CONCLUSIONS We developed and internally validated a prognostic model for patients with aUC receiving postplatinum immunotherapy. This model represents an improvement over the Bellmunt algorithm and could aid selection of patients with aUC for second-line immunotherapy. TRIAL REGISTRATION NUMBER NCT02928406.
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Affiliation(s)
- Aristotelis Bamias
- Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Chaidari, Greece
| | | | | | | | | | | | - F Lopez-Rios
- Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Fabio Calabrò
- GU Oncology Unit, San Camillo Forlanini Hospital, Roma, Italy
| | - Mario Kramer
- University Clinic Schleswig-Holstein-Lubeck, Lübeck, Germany
| | | | | | - Kimon Tzannis
- National and Kapodistrian University of Athens, Athens, Greece
| | - Cora N Sternberg
- Hematology and Oncology Englander Institute for Precision Medicine Weill Cornell Medicine, New York, New York, USA
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Makrakis D, Talukder R, Lin GI, Diamantopoulos LN, Dawsey S, Gupta S, Carril-Ajuria L, Castellano D, de Kouchkovsky I, Koshkin VS, Park JJ, Alva A, Bilen MA, Stewart TF, McKay RR, Tripathi N, Agarwal N, Vather-Wu N, Zakharia Y, Morales-Barrera R, Devitt ME, Cortellini A, Fulgenzi CAM, Pinato DJ, Nelson A, Hoimes CJ, Gupta K, Gartrell BA, Sankin A, Tripathi A, Zakopoulou R, Bamias A, Murgic J, Fröbe A, Rodriguez-Vida A, Drakaki A, Liu S, Lu E, Kumar V, Lorenzo GD, Joshi M, Isaacsson-Velho P, Buznego LA, Duran I, Moses M, Jang A, Barata P, Sonpavde G, Yu EY, Montgomery RB, Grivas P, Khaki AR. Association Between Sites of Metastasis and Outcomes With Immune Checkpoint Inhibitors in Advanced Urothelial Carcinoma. Clin Genitourin Cancer 2022; 20:e440-e452. [PMID: 35778337 PMCID: PMC10257151 DOI: 10.1016/j.clgc.2022.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Sites of metastasis have prognostic significance in advanced urothelial carcinoma (aUC), but more information is needed regarding outcomes based on metastatic sites in patients treated with immune checkpoint inhibitors (ICI). We hypothesized that presence of liver/bone metastases would be associated with worse outcomes with ICI. METHODS We identified a retrospective cohort of patients with aUC across 26 institutions, collecting demographics, clinicopathological, treatment, and outcomes information. Outcomes were compared with logistic (observed response rate; ORR) and Cox (progression-free survival; PFS, overall survival; OS) regression between patients with/without metastasis beyond lymph nodes (LN) and those with/without bone/liver/lung metastasis. Analysis was stratified by 1st or 2nd+ line. RESULTS We identified 917 ICI-treated patients: in the 1st line, bone/liver metastases were associated with shorter PFS (Hazard ratio; HR: 1.65 and 2.54), OS (HR: 1.60 and 2.35, respectively) and lower ORR (OR: 0.48 and 0.31). In the 2nd+ line, bone/liver metastases were associated with shorter PFS (HR: 1.71 and 1.62), OS (HR: 1.76 and 1.56) and, for bone-only metastases, lower ORR (OR: 0.29). In the 1st line, LN-confined metastasis was associated with longer PFS (HR: 0.53), OS (HR:0.49) and higher ORR (OR: 2.97). In the 2nd+ line, LN-confined metastasis was associated with longer PFS (HR: 0.47), OS (HR: 0.54), and higher ORR (OR: 2.79); all associations were significant. CONCLUSION Bone and/or liver metastases were associated with worse, while LN-confined metastases were associated with better outcomes in patients with aUC receiving ICI. These findings in a large population treated outside clinical trials corroborate data from trial subset analyses.
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Affiliation(s)
- Dimitrios Makrakis
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Rafee Talukder
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | | | | | - Scott Dawsey
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Shilpa Gupta
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Lucia Carril-Ajuria
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Daniel Castellano
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ivan de Kouchkovsky
- Division of Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Vadim S Koshkin
- Division of Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Joseph J Park
- Division of Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Ajjai Alva
- Division of Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Mehmet A Bilen
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Tyler F Stewart
- Division of Hematology/Oncology, Department of Medicine, University of California San Diego, La Jolla, CA
| | - Rana R McKay
- Division of Hematology/Oncology, Department of Medicine, University of California San Diego, La Jolla, CA
| | - Nishita Tripathi
- Division of Oncology, Department of Medicine, University of Utah, Salt Lake City, UT
| | - Neeraj Agarwal
- Division of Oncology, Department of Medicine, University of Utah, Salt Lake City, UT
| | | | - Yousef Zakharia
- Division of Oncology, Department of Medicine, University of Iowa, Iowa City, IA
| | - Rafael Morales-Barrera
- Vall d'Hebron Institute of Oncology, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Michael E Devitt
- Division of Hematology/Oncology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | | | | | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ariel Nelson
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Christopher J Hoimes
- Division of Medical Oncology, Seidman Cancer Center at Case Comprehensive Cancer Center, Cleveland, OH; Division of Medical Oncology, Duke University, Durham, NC
| | - Kavita Gupta
- Departments of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY
| | - Benjamin A Gartrell
- Departments of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY
| | - Alex Sankin
- Departments of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY
| | - Abhishek Tripathi
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Roubini Zakopoulou
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Aristotelis Bamias
- 2nd Propaedeutic Dept of Internal Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Jure Murgic
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb
| | - Ana Fröbe
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb; School of Dental Medicine, Zagreb, Croatia
| | - Alejo Rodriguez-Vida
- Medical Oncology Department, Hospital del Mar Research Institute, Barcelona, Spain
| | - Alexandra Drakaki
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sandy Liu
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Eric Lu
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Vivek Kumar
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Monika Joshi
- Division of Hematology/Oncology, Department of Medicine, Penn State Cancer Institute, Hershey, PA
| | - Pedro Isaacsson-Velho
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Division of Oncology, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | - Ignacio Duran
- Hospital Universitario Marques de Valdecilla. IDIVAL. Santander, Spain
| | - Marcus Moses
- Deming Department of Medicine, Section of Hematology/Oncology, Tulane University, New Orleans, LA
| | - Albert Jang
- Deming Department of Medicine, Section of Hematology/Oncology, Tulane University, New Orleans, LA
| | - Pedro Barata
- Deming Department of Medicine, Section of Hematology/Oncology, Tulane University, New Orleans, LA
| | - Guru Sonpavde
- Genitourinary Oncology Program, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Evan Y Yu
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Robert Bruce Montgomery
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Petros Grivas
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA.
| | - Ali Raza Khaki
- Division of Oncology, Department of Medicine, Stanford University, Palo Alto, CA.
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Alqaisi HA, Stecca C, Veitch ZW, Riromar J, Kaiser J, Fallah-Rad N, Jiang DM, North S, Samnani S, Alimohamed N, Sridhar SS. The prognostic impact of bone metastasis in patients with metastatic urothelial carcinoma treated with first-line platinum-based chemotherapy. Ther Adv Med Oncol 2022; 14:17588359221094879. [PMID: 35520101 PMCID: PMC9066632 DOI: 10.1177/17588359221094879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/31/2022] [Indexed: 12/24/2022] Open
Abstract
Background: In metastatic urothelial cancer (mUC), bone metastasis (BM) are associated with significant morbidity and mortality, yet their role as an independent prognostic variable remains unclear. We aimed to determine the impact of BM on overall survival (OS) in patients with mUC treated with first-line platinum-based chemotherapy (PBC). Methods: mUC patients receiving PBC at the Princess Margaret Cancer Center, Tom Baker Cancer Center, or Cross Cancer Institute from January 2005 to January 2018 were identified retrospectively using central pharmacy database records. Patient disease, treatment, and response characteristics were collected. Progression-free survival (PFS) and OS were estimated using the Kaplan–Meier method. Variables reaching significance (p < 0.05) in univariable analysis (UVA) of survival (OS) were included in multivariable analysis (MVA) (Cox). Results: Overall, 376 patients with a median follow-up of 16.8 (range: 2.2–218.3) months were included. Median age was 67 (range: 28–91) years, 76% were male, 63% had an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0–1, and 41% had BM. All patients received first-line PBC. Patients with BM had inferior median PFS (4.9 months (95% CI 3.6–6.2) versus 6.5 months (95% CI 5.4–7.6), p = 0.03) and median OS (8.8 months (95% CI 7.8–9.7) versus 10.8 months (95% CI 9.1–12.5), p = 0.002). In UVA, ECOG PS 2–3 (p < 0.001), presence of BM (p = 0.002), and WBC count ⩾ 11,000 cells/mm3 (p = 0.001) were associated with inferior survival. Prior cystectomy (p < 0.001) and lack of progression (stable disease, partial or complete response) on treatment was associated with improved OS (p < 0.001). These variables maintained significance in MVA. Conclusion: In this retrospective study, mUC patients with BM had worse OS suggesting that BM may be an independent negative prognostic factor and including BM as a stratification factor in future mUC clinical trial designs may be warranted. A greater focus must be placed on novel therapeutic strategies to better manage BM to reduce both morbidity and mortality.
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Affiliation(s)
- Husam A. Alqaisi
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Carlos Stecca
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Zachary W. Veitch
- Division of Medical Oncology and Hematology, St. Michael’s Hospital, Toronto, ON, Canada
| | - Jamila Riromar
- National Oncology Center (NOC) Royal Hospital, Muscat, Oman
| | - Jeenan Kaiser
- Division of Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Nazanin Fallah-Rad
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Di Maria Jiang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Scott North
- Division of Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Sunil Samnani
- Division of Medical Oncology and Hematology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Nimira Alimohamed
- Division of Medical Oncology and Hematology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Srikala S. Sridhar
- Professor of Medicine, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 700 University Avenue, Toronto, ON M5G 1Z5, Canada
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