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Bakaloudi DR, Talukder R, Lin GI, Makrakis D, Diamantopoulos LN, Tripathi N, Agarwal N, Zakopoulou R, Bamias A, Brown JR, Pinato DJ, Korolewicz J, Jindal T, Koshkin VS, Murgić J, Miletić M, Frobe A, Johnson J, Zakharia Y, Drakaki A, Rodriguez-Vida A, Rey-Cárdenas M, Castellano D, Buznego LA, Duran I, Carballeira CC, Barrera RM, Marmorejo D, McKay RR, Stewart T, Gupta S, Ruplin AT, Yu EY, Khaki AR, Grivas P. Response and Outcomes of Maintenance Avelumab After Platinum-Based Chemotherapy (PBC) in Patients With Advanced Urothelial Carcinoma (aUC): "Real World" Experience. Clin Genitourin Cancer 2023; 21:584-593. [PMID: 37414620 DOI: 10.1016/j.clgc.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Platinum-based chemotherapy (PBC) followed by avelumab switch maintenance in nonprogressors is standard first line (1L) treatment for advanced urothelial carcinoma (aUC). We describe clinical features and outcomes in a "real-world' cohort treated with avelumab maintenance for aUC. MATERIALS AND METHODS This was a retrospective cohort study of patients (pts) who received 1L switch maintenance avelumab after no progression on PBC for aUC. We calculated progression-free survival (PFS) and overall survival (OS) from initiation of maintenance avelumab. We also described OS and PFS for specific subsets using Cox regression and observed response rate (ORR). RESULTS A total of 108 pts with aUC from 14 sites treated with maintenance avelumab were included. There was a median of 6 weeks1-30 from end of PBC to avelumab initiation; median follow-up time from avelumab initiation was 8.8 months (1-42.7). Median [m]PFS was 9.6 months (95%CI 7.5-12.1) and estimated 1-year OS was 72.5%. CR/PR (vs. SD) to 1L PBC (HR = 0.33, 95% CI 0.13-0.87) and ECOG PS 0 (vs. ≥1), (HR = 0.15, 95% CI 0.05-0.47) were associated with longer OS. The presence of liver metastases was associated with shorter PFS (HR = 2.32, 95% CI 1.17-4.59). ORR with avelumab maintenance was 28.7% (complete response 17.6%, partial response 11.1%), 29.6% stable disease, 26.9% progressive disease as best response (14.8% best response unknown). CONCLUSIONS Results seem relatively consistent with findings from JAVELIN Bladder100 trial and recent "real world" studies. Prior response to platinum-based chemotherapy, ECOG PS 0, and absence of liver metastases were favorable prognostic factors. Limitations include the retrospective design, lack of randomization and central scan review, and possible selection/confounding biases.
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Affiliation(s)
| | - Rafee Talukder
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | | | - Dimitrios Makrakis
- Department of Medicine, Jacobi Medical Center-Albert Einstein College of Medicine, Bronx, NY
| | | | - 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
| | - Roubini Zakopoulou
- 2nd Propaedeutic Department of Internal Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Aristotelis Bamias
- 2nd Propaedeutic Department of Internal Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Jason R Brown
- Division of Oncology, University Hospitals Seidman Cancer Center, Clevelant, OH
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK; Division of Oncology, Department of Translational Medicine (DIMET), University of Piemonte Orientale, Novara, Italy
| | - James Korolewicz
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK
| | - Tanya Jindal
- Division of Hematology/Oncology, Department of Medicine, Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA
| | - Vadim S Koshkin
- Division of Hematology/Oncology, Department of Medicine, Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA
| | - Jure Murgić
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, School of Dental Medicine, Zagreb, Croatia
| | - Marija Miletić
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, School of Dental Medicine, Zagreb, Croatia
| | - Ana Frobe
- Department of Oncology and Nuclear Medicine, Faculty of Dentistry, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Jeffrey Johnson
- Division of Oncology, Department of Medicine, University of Iowa, Iowa City, IA
| | - Yousef Zakharia
- Division of Oncology, Department of Medicine, University of Iowa, Iowa City, IA
| | - Alexandra Drakaki
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Alejo Rodriguez-Vida
- Medical Oncology Department, Hospital del Mar, IMM Research Institute, Barcelona, Spain
| | | | - Daniel Castellano
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Lucia Alonso Buznego
- Department of Oncology, University Hospital Marqués of Valdecilla, IDIVAL Santander, Cantabria, Spain
| | - Ignacio Duran
- Department of Oncology, University Hospital Marqués of Valdecilla, IDIVAL Santander, Cantabria, Spain
| | - Clara Castro Carballeira
- Department of Oncology, University Hospital Marqués of Valdecilla, IDIVAL Santander, Cantabria, Spain
| | - Rafael Morales Barrera
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Marmorejo
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rana R McKay
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Tyler Stewart
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Shilpa Gupta
- Department of Hematology and Oncology, Taussig cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Evan Y Yu
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Ali R Khaki
- Division of Oncology, Department of Medicine, Stanford University, Palo Alto, CA.
| | - Petros Grivas
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA.
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Sekar RR, Diamantopoulos LN, Bakaloudi DR, Khaki AR, Grivas P, Winters BR, Vakar-Lopez F, Tretiakova MS, Psutka SP, Holt SK, Gore JL, Lin DW, Schade GR, Hsieh AC, Lee JK, Yezefski T, Schweizer MT, Cheng HH, Yu EY, True LD, Montgomery RB, Wright JL. Sarcomatoid Urothelial Carcinoma Is Associated With Limited Response to Neoadjuvant Chemotherapy and Poor Oncologic Outcomes After Radical Cystectomy. Clin Genitourin Cancer 2023; 21:507.e1-507.e14. [PMID: 37150667 PMCID: PMC10621753 DOI: 10.1016/j.clgc.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION To examine oncologic outcomes and response to neoadjuvant chemotherapy (NAC) in patients with sarcomatoid urothelial carcinoma (SUC) treated with radical cystectomy (RC). MATERIALS AND METHODS We retrospectively queried our institutional database (2003-18) and Surveillance, Epidemiology, and End Results (SEER)-Medicare (2004-2015) for patients with cT2-4, N0-2, M0 SUC and conventional UC (CUC) treated with RC. Clinicopathologic characteristics were described using descriptive statistics (t test, χ2-test and log-rank-test for group comparison). Overall (OS) and recurrence-free-survival (RFS) after RC were estimated with the Kaplan Meier method and associations with OS were evaluated with Cox proportional hazards models. RESULTS We identified 38 patients with SUC and 287 patients with CUC in our database, and 190 patients with SUC in SEER-Medicare. In the institutional cohort, patients with SUC versus CUC had higher rates of pT3/4 stage (66% vs. 35%, P < 0.001), lower rates of ypT0N0 (6% vs. 35%, P = .02), and worse median OS (17.5 vs. 120 months, P < .001). Further, patients with SUC in the institutional versus SEER-Medicare cohort had similar median OS (17.5 vs. 21 months). In both cohorts, OS was comparable between patients with SUC undergoing NAC+RC vs. RC alone (17.5 vs. 18.4 months, P = .98, institutional cohort; 24 vs. 20 months, P = .56, SEER cohort). In Cox proportional hazards models for the institutional RC cohort, SUC was independently associated with worse OS (HR 2.3, CI 1.4-3.8, P = .001). CONCLUSION SUC demonstrates poor pathologic response to NAC and worse OS compared with CUC, with no OS benefit associated with NAC. A unique pattern of rapid abdominopelvic cystic recurrence was identified.
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Affiliation(s)
- Rishi R Sekar
- Department of Urology, University of Michigan, Ann Arbor, MI.
| | | | - Dimitra R Bakaloudi
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Ali R Khaki
- Division of Oncology, Department of Medicine, Stanford University, Palo Alto, CA
| | - Petros Grivas
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Brian R Winters
- Department of Urology, Kaiser Permanente Washington, Bellevue, Washington
| | - Funda Vakar-Lopez
- Department of Pathology, University of Washington School of Medicine, Seattle, WA
| | - Maria S Tretiakova
- Department of Pathology, University of Washington School of Medicine, Seattle, WA
| | - Sarah P Psutka
- Fred Hutchinson Cancer Center, Seattle, WA; Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Sarah K Holt
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - John L Gore
- Fred Hutchinson Cancer Center, Seattle, WA; Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Daniel W Lin
- Fred Hutchinson Cancer Center, Seattle, WA; Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - George R Schade
- Fred Hutchinson Cancer Center, Seattle, WA; Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Andrew C Hsieh
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - John K Lee
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Todd Yezefski
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Michael T Schweizer
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Heather H Cheng
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Evan Y Yu
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Lawrence D True
- Department of Pathology, University of Washington School of Medicine, Seattle, WA
| | - R Bruce Montgomery
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Jonathan L Wright
- Fred Hutchinson Cancer Center, Seattle, WA; Department of Urology, University of Washington School of Medicine, Seattle, WA
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Diamantopoulos LN, Kalligeros M, Halfdanarson TR, Diamantis N, Toumpanakis C. Combination Systemic Therapies in Advanced Well-Differentiated Gastroenteropancreatic Neuroendocrine Tumors (GEP-NETs): A Comprehensive Review of Clinical Trials and Prospective Studies. Biology (Basel) 2023; 12:1069. [PMID: 37626955 PMCID: PMC10452098 DOI: 10.3390/biology12081069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 08/27/2023]
Abstract
There is an evolving landscape of systemic combination regimens for patients with advanced well-differentiated gastroenteropancreatic neuroendocrine tumors (GEP-NETs). In this review, we provide a comprehensive outline of the existing clinical trials/prospective studies investigating these combinations. PubMed was searched using key relevant terms to identify articles referring to GEP-NETs and combination treatments. No systematic search of the literature or metanalysis of the data was performed, and we focused on the most recent literature results. Primarily, phase 1 and 2 clinical trials were available, with a smaller number of phase 3 trials, reporting results from combination treatments across a wide range of antiproliferative agents. We identified significant variability in the anti-tumor activity of the reported combinations, with occasional promising results, but only a very small number of practice-changing phase 3 clinical trials. Overall, the peptide receptor radionuclide therapy (PRRT)-based combinations (with chemotherapy, dual PPRT, and targeted agents) and anti-vascular endothelial growth factor (VEGF) agent combinations with standard chemotherapy were found to have favorable results and may be worth investigating in future, larger-scale trials. In contrast, the immune-checkpoint inhibitor-based combinations were found to have limited applicability in advanced, well-differentiated GEP-NETs.
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Affiliation(s)
- Leonidas N. Diamantopoulos
- Department of Medicine, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA;
| | - Markos Kalligeros
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA;
| | | | - Nikolaos Diamantis
- Department of Medical Oncology, Royal Free London NHS Foundation Trust and University College London, London WC1E 6BT, UK;
| | - Christos Toumpanakis
- Neuroendocrine Tumor Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust and University College London, London WC1E 6BT, UK
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Makrakis D, Bakaloudi DR, Talukder R, Lin GI, Diamantopoulos LN, Jindal T, Vather-Wu N, Zakharia Y, Tripathi N, Agarwal N, Dawsey S, Gupta S, Lu E, Drakaki A, Liu S, Zakopoulou R, Bamias A, Fulgenzi CM, Cortellini A, Pinato D, Barata P, Grivas P, Khaki AR, Koshkin VS. Treatment Rechallenge With Immune Checkpoint Inhibitors in Advanced Urothelial Carcinoma. Clin Genitourin Cancer 2023; 21:286-294. [PMID: 36481176 DOI: 10.1016/j.clgc.2022.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/30/2022] [Accepted: 11/07/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To examine patient and disease characteristics, toxicity, and clinical outcomes for patients with advanced urothelial carcinoma (aUC) who are rechallenged with immune checkpoint inhibitor (ICI)-based therapy. PATIENTS AND METHODS In this retrospective cohort, we included patients treated with ICI for aUC after having prior ICI treatment. Endpoints included the evaluation of radiographic response and disease control rates with first and second ICI courses, outcomes based on whether there was a change in ICI class (anti-PD-1 vs. anti-PD-L1), and assessment of the reasons for ICI discontinuation. RESULTS We identified 25 patients with aUC from 9 institutions who received 2 separate ICI courses. ORR with first ICI and second ICI were 39% and 13%, respectively. Most patients discontinued first ICI due to progression (n = 19) or treatment-related toxicity (n = 4). Thirteen patients received non-ICI treatment between the first and second ICI, and 12 patients changed ICI class (anti-PD-1 vs. anti-PD-L1) at rechallenge. Among 10 patients who changed ICI class, 8 (80%) had progressive disease as best response with second ICI, while among 12 patients re-treated with the same ICI class, only 3 (25%) had progressive disease as best response at the time of rechallenge. With second ICI, most patients discontinued treatment due to progression (n = 18) or patient preference (n = 2). CONCLUSIONS A proportion of patients with aUC rechallenged with ICI-based regimens may achieve disease control, supporting clinical trials in that setting, especially with ICI-based combinations. Future studies are needed to validate our results and should also focus on identifying biomarkers predictive of benefit with ICI rechallenge.
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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
| | | | | | - Tanya Jindal
- Helen Diller Family Cancer Center, University of California, San Francisco, San Francisco, CA
| | | | - Yousef Zakharia
- Division of Oncology, Department of Medicine, University of Iowa, Iowa City, IA
| | - 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
| | - 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
| | - Eric Lu
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - 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
| | - Roubini Zakopoulou
- 2nd Propaedeutic Department of Internal Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Aristotelis Bamias
- 2nd Propaedeutic Department of Internal Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Claudia-Maria Fulgenzi
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London; Department of Medical Oncology, University Campus Bio-Medico of Rome, Italy
| | - Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London; Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - David Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Pedro Barata
- Tulane Medical School, New Orleans, LA; University Hospitals Seidman Cancer Center, Cleveland, OH
| | - 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, Stanford, CA
| | - Vadim S Koshkin
- Division of Hematology/Oncology, Department of Medicine, Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA.
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Diamantopoulos LN, Makrakis D, Korentzelos D, Alevizakos M, Wright JL, Grivas P, Bountziouka V, Vadikolias K, Lambropoulou M, Tripsianis G. Development and validation of a prognostic nomogram for overall and disease-specific survival in patients with sarcomatoid urothelial carcinoma. Urol Oncol 2023:S1078-1439(23)00046-7. [PMID: 36931981 DOI: 10.1016/j.urolonc.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/29/2022] [Accepted: 01/27/2023] [Indexed: 03/17/2023]
Abstract
INTRODUCTION Sarcomatoid urothelial carcinoma (SUC) is a rare and aggressive variant of bladder cancer with limited data guiding prognosis. In this study, we present the first prognostic nomograms in the literature for 3- and 5-year overall survival (OS) and disease-specific survival (DSS), for patients with SUC derived from the surveillance, epidemiology and end results database (SEER). MATERIALS AND METHODS Patients with SUC were identified by using the ICD-10 topography codes C67.0-C67.9 (bladder cancer), and the morphologic code 8122 (SUC). Patients were randomly divided into a training cohort (TC) and a validation cohort (VC) (7:3 ratio). Variables significantly associated with OS and DSS were identified with multivariate Cox regression and were used to build the nomograms. Harrel's C-statistic with bootstrap resampling and calibration curves were used for internal (TC) and external (VC) validation. Clinical utility of the nomograms was assessed with the decision curve analysis (DCA). Goodness of fit between the nomograms and the AJCC 8th edition staging system was compared with the likelihood ratio test. RESULTS A total of 741 patients with SUC were included (507 TC, 234 VC). No statistically significant differences in baseline characteristics were identified between the 2 cohorts. Sex, SEER stage, radical cystectomy and chemotherapy were common variables for the OS and the DSS nomograms with the addition of age in the former. Optimism-corrected C-statistic for the nomograms was 0.68 and 0.67 for OS and DSS respectively. In comparison, C-statistic for AJCC was 0.59 for OS and 0.60 for DSS (P < 0.001). Calibration curves constructed for the nomograms showed appropriate consistency between predicted and actual survival. The nomograms demonstrated optimal clinical utility in the DCA, outperforming the AJCC staging system, by maintaining a higher clinical net benefits than treat all, treat none and AJCC curves, across threshold probabilities. CONCLUSION We present the first prognostic nomograms developed in patients with SUC. Our models demonstrated superior prognostic performance to the AJCC system, by utilizing a set of variables readily available in daily practice and may serve as useful tools for the individualized risk assessment of these patients.
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Affiliation(s)
- Leonidas N Diamantopoulos
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Medical Statistics, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Dimitrios Makrakis
- Department of Medicine, Jacobi Medical Center-Albert Einstein College of Medicine, Bronx, NY
| | | | - Michail Alevizakos
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Petros Grivas
- Division of Medical Oncology, Department of Medicine, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA
| | - Vasiliki Bountziouka
- Division of Medical Biostatistics, Department of Food Science and Nutrition, University of The Aegean, Myrina, Lemnos, Greece
| | - Konstantinos Vadikolias
- Department of Medical Statistics, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Lambropoulou
- Department of Pathology, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Gregory Tripsianis
- Department of Medical Statistics, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
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Korentzelos D, Elishaev E, Zhao C, Jones MW, Soong TR, Lesnock J, Orellana T, Zeccola A, Diamantopoulos LN, Wald AI, Bhargava R. ARID1A, BRG1, and INI1 deficiency in undifferentiated and dedifferentiated endometrial carcinoma: a clinicopathologic, immunohistochemical, and next-generation sequencing analysis of a case series from a single institution. Hum Pathol 2022; 130:65-78. [PMID: 36252860 DOI: 10.1016/j.humpath.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/11/2022] [Accepted: 10/04/2022] [Indexed: 11/04/2022]
Abstract
Undifferentiated/dedifferentiated endometrial carcinomas (UDEC and DDEC) are rare, aggressive uterine neoplasms, with no specific line of differentiation. A significant proportion of these cases feature mutations of SWI/SNF chromatin remodeling complex members, including ARID1A, SMARCA4, and SMARCB1 genes. To study these entities more comprehensively, we identified 10 UDECs and 10 DDECs from our pathology archives, obtained clinicopathologic findings and follow-up data, and performed immunohistochemical studies for ARID1A, BRG1 (SMARCA4), and INI1 (SMARCB1) proteins. In addition, we successfully conducted targeted next-generation sequencing for 23 samples, including 7 UDECs, and 7 undifferentiated and 9 well/moderately-differentiated components of DDECs. Cases consisted of 18 hysterectomies and 2 curettage/biopsy specimens. Patient age ranged from 47 to 77 years (median, 59 years), with a median tumor size of 8.0 cm (range, 2.5-13.0 cm). All cases demonstrated lymphovascular invasion and the majority (13/20) were FIGO stage III-IV. By immunohistochemistry, ARID1A loss was observed in 15 cases, BRG1 loss in 4, and all cases had intact INI1 expression. A trend for enrichment of the undifferentiated component of DDECs for ARID1A loss was seen, although not statistically significant. Sequencing revealed frequent pathogenic mutations in PTEN, PIK3CA, ARID1A, CTNNB1, and RNF43, a recurrent MAX pathogenic mutation, and MYC and 12p copy number gains. In DDECs, the undifferentiated component featured a higher tumor mutational burden compared to the well/moderately-differentiated component; however, the mutational landscape largely overlapped. Overall, our study provides deep insights into the mutational landscape of UDEC/DDEC, SWI/SNF chromatin remodeling complex member status, and their potential relationships with tumor features.
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Affiliation(s)
- Dimitrios Korentzelos
- Department of Pathology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA 15213, USA
| | - Esther Elishaev
- Department of Pathology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA 15213, USA; UPMC Magee-Womens Hospital, Pittsburgh, PA 15213, USA
| | - Chengquan Zhao
- Department of Pathology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA 15213, USA; UPMC Magee-Womens Hospital, Pittsburgh, PA 15213, USA
| | - Mirka W Jones
- Department of Pathology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA 15213, USA; UPMC Magee-Womens Hospital, Pittsburgh, PA 15213, USA
| | - T Rinda Soong
- Department of Pathology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA 15213, USA; UPMC Magee-Womens Hospital, Pittsburgh, PA 15213, USA
| | - Jamie Lesnock
- Division of Gynecologic Oncology, UPMC Magee-Womens Hospital, Pittsburgh, PA 15213, USA
| | - Taylor Orellana
- Division of Gynecologic Oncology, UPMC Magee-Womens Hospital, Pittsburgh, PA 15213, USA
| | - Alison Zeccola
- Division of Gynecologic Oncology, UPMC Magee-Womens Hospital, Pittsburgh, PA 15213, USA
| | | | - Abigail I Wald
- Department of Pathology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA 15213, USA
| | - Rohit Bhargava
- Department of Pathology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA 15213, USA; UPMC Magee-Womens Hospital, Pittsburgh, PA 15213, USA.
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Talukder R, Makrakis D, Lin GI, Diamantopoulos LN, Dawsey S, Gupta S, Carril-Ajuria L, Castellano D, de Kouchkovsky I, Jindal T, 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, Barata P, Sonpavde G, Wright JL, Yu EY, Montgomery RB, Hsieh AC, Grivas P, Khaki AR. Association of the Time to Immune Checkpoint Inhibitor (ICI) Initiation and Outcomes With Second Line ICI in Patients With Advanced Urothelial Carcinoma. Clin Genitourin Cancer 2022; 20:558-567. [PMID: 36155169 PMCID: PMC10233855 DOI: 10.1016/j.clgc.2022.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/15/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Early progression on first-line (1L) platinum-based therapy or between therapy lines may be a surrogate of more aggressive disease and poor outcomes in advanced urothelial carcinoma (aUC), but its prognostic role regarding immune checkpoint inhibitor (ICI) response and survival is unclear. We hypothesized that shorter time until start of second-line (2L) ICI would be associated with worse outcomes in aUC. PATIENTS AND METHODS We performed a retrospective multi-institution cohort study in patients with aUC treated with 1L platinum-based chemotherapy, who received 2L ICI. Patients receiving switch maintenance ICI were excluded. We defined time to 2L ICI therapy as the time between the start of 1L platinum-based chemotherapy to the start of 2L ICI and categorized patients a priori into 1 of 3 groups: less than 3 months versus 3-6 months versus more than 6 months. We calculated overall response rate (ORR) with 2L ICI, progression-free survival (PFS) and overall survival (OS) from the start of 2L ICI. ORR was compared among the 3 groups using multivariable logistic regression, and PFS, OS using cox regression. Multivariable models were adjusted for known prognostic factors. RESULTS We included 215, 215, and 219 patients in the ORR, PFS, and OS analyses, respectively, after exclusions. ORR difference did not reach statistical significance between patients with less than 3 months versus 3-6 months versus more than 6 months to 2L ICI. However, PFS (HR 1.64; 95% CI 1.02-2.63) and OS (HR 1.77; 95% CI 1.10-2.84) was shorter among those with time to 2L ICI less than 3 months compared to those who initiated 2L ICI more than 6 months. CONCLUSION Among patients with aUC treated with 2L ICI, time to 2L ICI less than 3 months was associated with lower, but not significantly different ORR, but shorter PFS and OS compared to 2L ICI more than 6 months. This highlights potential cross resistance mechanisms between ICI and platinum-based chemotherapy.
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Affiliation(s)
- Rafee Talukder
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Dimitrios Makrakis
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | | | | | - Scott Dawsey
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Shilpa Gupta
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Daniel Castellano
- Department of Medical Oncology, Hospital Universitario, Madrid, Spain
| | - Ivan de Kouchkovsky
- Division of Oncology, Department of Medicine, University of California, San Francisco, CA
| | - Tanya Jindal
- Division of Oncology, Department of Medicine, University of California, San Francisco, CA
| | - Vadim S Koshkin
- Division of Oncology, Department of Medicine, University of California, 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
| | - 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 Department 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
| | - 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
| | - Jonathan L Wright
- Fred Hutchinson Cancer Center, Seattle, WA; Department of Urology, University of Washington, Seattle, WA
| | - Evan Y Yu
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Robert Bruce Montgomery
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Andrew C Hsieh
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Petros Grivas
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA.
| | - Ali Raza Khaki
- Division of Oncology, Department of Medicine, Stanford University, Palo Alto, CA.
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8
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Makrakis D, Talukder R, Diamantopoulos LN, Carril-Ajuria L, Castellano D, De Kouchkovsky I, Koshkin VS, Park JJ, Alva A, Bilen MA, Stewart TF, McKay RR, Santos VS, Agarwal N, Jain J, Zakharia Y, Morales-Barrera R, Devitt ME, Grant M, Lythgoe MP, Pinato DJ, Nelson A, Hoimes CJ, Shreck E, Gartrell BA, Sankin A, Tripathi A, Zakopoulou R, Bamias A, Murgic J, Fröbe A, Rodriguez-Vida A, Drakaki A, Liu S, Kumar V, Di Lorenzo G, Joshi M, Isaacsson-Velho P, Buznego LA, Duran I, Moses M, Barata P, Sonpavde G, Yu EY, Wright JL, Grivas P, Khaki AR. Association of prior local therapy and outcomes with programmed-death ligand-1 inhibitors in advanced urothelial cancer. BJU Int 2022; 130:592-603. [PMID: 34597472 DOI: 10.1111/bju.15603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/09/2021] [Accepted: 09/08/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To compare clinical outcomes with programmed-death ligand-1 immune checkpoint inhibitors (ICIs) in patients with advanced urothelial carcinoma (aUC) who have vs have not undergone radical surgery (RS) or radiation therapy (RT) prior to developing metastatic disease. PATIENTS AND METHODS We performed a retrospective cohort study collecting clinicopathological, treatment and outcomes data for patients with aUC receiving ICIs across 25 institutions. We compared outcomes (observed response rate [ORR], progression-free survival [PFS], overall survival [OS]) between patients with vs without prior RS, and by type of prior locoregional treatment (RS vs RT vs no locoregional treatment). Patients with de novo advanced disease were excluded. Analysis was stratified by treatment line (first-line and second-line or greater [second-plus line]). Logistic regression was used to compare ORR, while Kaplan-Meier analysis and Cox regression were used for PFS and OS. Multivariable models were adjusted for known prognostic factors. RESULTS We included 562 patients (first-line: 342 and second-plus line: 220). There was no difference in outcomes based on prior locoregional treatment among those treated with first-line ICIs. In the second-plus-line setting, prior RS was associated with higher ORR (adjusted odds ratio 2.61, 95% confidence interval [CI]1.19-5.74]), longer OS (adjusted hazard ratio [aHR] 0.61, 95% CI 0.42-0.88) and PFS (aHR 0.63, 95% CI 0.45-0.89) vs no prior RS. This association remained significant when type of prior locoregional treatment (RS and RT) was modelled separately. CONCLUSION Prior RS before developing advanced disease was associated with better outcomes in patients with aUC treated with ICIs in the second-plus-line but not in the first-line setting. While further validation is needed, our findings could have implications for prognostic estimates in clinical discussions and benchmarking for clinical trials. Limitations include the study's retrospective nature, lack of randomization, and possible selection and confounding biases.
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Affiliation(s)
- Dimitrios Makrakis
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Rafee Talukder
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - 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, USA
| | - Vadim S Koshkin
- Division of Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Joseph J Park
- Division of Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ajjai Alva
- Division of Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mehmet A Bilen
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Tyler F Stewart
- Division of Hematology/Oncology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Rana R McKay
- Division of Hematology/Oncology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Victor S Santos
- Division of Oncology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Neeraj Agarwal
- Division of Oncology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jayanshu Jain
- Department of Medicine, University of Iowa, Iowa City, IA, USA
| | - Yousef Zakharia
- Division of Oncology, Department of Medicine, University of Iowa, Iowa City, IA, USA
| | - 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, USA
| | - Michael Grant
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Mark P Lythgoe
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ariel Nelson
- Division of Medical Oncology, Seidman Cancer Center at Case Comprehensive Cancer Center, Cleveland, OH, USA.,Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christopher J Hoimes
- Division of Medical Oncology, Seidman Cancer Center at Case Comprehensive Cancer Center, Cleveland, OH, USA.,Division of Medical Oncology, Duke University, Durham, NC, USA
| | - Evan Shreck
- Departments of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Benjamin A Gartrell
- Departments of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Alex Sankin
- Departments of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Abhishek Tripathi
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Roubini Zakopoulou
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Aristotelis Bamias
- 2nd Propaedeutic Department 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, Croatia
| | - Ana Fröbe
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia.,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, USA
| | - Sandy Liu
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Vivek Kumar
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Monika Joshi
- Division of Hematology/Oncology, Department of Medicine, Penn State Cancer Institute, Hershey, PA, USA
| | - Pedro Isaacsson-Velho
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.,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, USA
| | - Pedro Barata
- Deming Department of Medicine, Section of Hematology/Oncology, Tulane University, New Orleans, LA, USA
| | - Guru Sonpavde
- Genitourinary Oncology Program, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Evan Y Yu
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Petros Grivas
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ali Raza Khaki
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Division of Oncology, Department of Medicine, Stanford University, Palo Alto, CA, USA
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9
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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Talukder R, Makrakis D, Diamantopoulos LN, Carril-Ajuria L, Castellano D, De Kouchkovsky I, Koshkin VS, Park JJ, Alva A, Bilen MA, Stewart TF, McKay RR, Santos VS, Agarwal N, Jain J, Zakharia Y, Morales-Barrera R, Devitt ME, Grant M, Lythgoe MP, Pinato DJ, Nelson A, Hoimes CJ, Shreck E, Gartrell BA, Sankin A, Tripathi A, Zakopoulou R, Bamias A, Murgic J, Fröbe A, Rodriguez-Vida A, Drakaki A, Liu S, Kumar V, Di Lorenzo G, Joshi M, Velho PI, Buznego LA, Duran I, Moses M, Barata P, Sonpavde G, Yu EY, Wright JL, Grivas P, Khaki AR. Response and Outcomes to Immune Checkpoint Inhibitors in Advanced Urothelial Cancer Based on Prior Intravesical Bacillus Calmette-Guerin. Clin Genitourin Cancer 2022; 20:165-175. [PMID: 35078711 PMCID: PMC8995351 DOI: 10.1016/j.clgc.2021.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) improve overall survival (OS) in patients with locally advanced, unresectable, or metastatic urothelial carcinoma (aUC), but response rates can be modest. We compared outcomes between patients with and without prior intravesical Bacillus Calmette-Guerin (BCG), who received ICI for aUC, hypothesizing that prior intravesical BCG would be associated with worse outcomes. PATIENTS AND METHODS We performed a retrospective cohort study across 25 institutions in US and Europe. We compared observed response rate (ORR) using logistic regression; progression-free survival (PFS) and OS using Kaplan-Meier and Cox proportional hazards. Analyses were stratified by treatment line (first line/salvage) and included multivariable models adjusting for known prognostic factors. RESULTS A total of 1026 patients with aUC were identified; 614, 617, and 638 were included in ORR, OS, PFS analyses, respectively. Overall, 150 pts had history of prior intravesical BCG treatment. ORR to ICI was similar between those with and without prior intravesical BCG exposure in both first line and salvage settings (adjusted odds radios 0.55 [P= .08] and 1.65 [P= .12]). OS (adjusted hazard ratios 1.05 [P= .79] and 1.13 [P= .49]) and PFS (adjusted hazard ratios 1.12 [P= .55] and 0.87 [P= .39]) were similar between those with and without intravesical BCG exposure in first line and salvage settings. CONCLUSION Prior intravesical BCG was not associated with differences in response and survival in patients with aUC treated with ICI. Limitations include retrospective nature, lack of randomization, presence of selection and confounding biases. This study provides important preliminary data that prior intravesical BCG exposure may not impact ICI efficacy in aUC.
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Affiliation(s)
- Rafee Talukder
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Dimitrios Makrakis
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | | | - 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
| | | | - 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
| | - Victor S. Santos
- 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
| | - Jayanshu Jain
- Department of Medicine, University of Iowa, Iowa City, IA
| | - 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
| | - Michael Grant
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Mark P. Lythgoe
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - David J. Pinato
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ariel Nelson
- Division of Medical Oncology, Seidman Cancer Center at Case Comprehensive Cancer Center, Cleveland, OH.,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
| | - Evan Shreck
- 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, School of Dental Medicine, Zagreb, Croatia
| | - 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
| | - 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
| | | | | | - 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
| | - 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 Research Center, Seattle, WA
| | - Jonathan L. Wright
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.,Department of Urology, University of Washington, Seattle, WA
| | - Petros Grivas
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
| | - Ali Raza Khaki
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Division of Oncology, Department of Medicine, Stanford University, Palo Alto, CA.
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Diamantopoulos LN, Appleman LJ. HLA-A*03 and response to immune checkpoint blockade in patients with cancer. Lancet Oncol 2022; 23:e99. [DOI: 10.1016/s1470-2045(22)00086-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 10/19/2022]
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12
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Diamantopoulos LN, Korentzelos D, Alevizakos M, Wright JL, Grivas P, Appleman LJ. Sarcomatoid Urothelial Carcinoma: A Population-Based Study Of Clinicopathologic Characteristics And Survival Outcomes. Clin Genitourin Cancer 2021; 20:139-147. [DOI: 10.1016/j.clgc.2021.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 11/28/2021] [Accepted: 12/07/2021] [Indexed: 12/18/2022]
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13
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Esagian SM, Khaki AR, Diamantopoulos LN, Carril-Ajuria L, Castellano D, De Kouchkovsky I, Park JJ, Alva A, Bilen MA, Stewart TF, McKay RR, Santos VS, Agarwal N, Jain J, Zakharia Y, Morales-Barrera R, Devitt ME, Nelson A, Hoimes CJ, Shreck E, Gartrell BA, Sankin A, Tripathi A, Zakopoulou R, Bamias A, Rodriguez-Vida A, Drakaki A, Liu S, Kumar V, Lythgoe MP, Pinato DJ, Murgic J, Fröbe A, Joshi M, Isaacsson Velho P, Hahn N, Alonso Buznego L, Duran I, Moses M, Barata P, Galsky MD, Sonpavde G, Yu EY, Msaouel P, Koshkin VS, Grivas P. Immune checkpoint inhibitors in advanced upper and lower tract urothelial carcinoma: a comparison of outcomes. BJU Int 2021; 128:196-205. [PMID: 33556233 DOI: 10.1111/bju.15324] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To compare clinical outcomes between patients with locally advanced (unresectable) or metastatic urothelial carcinoma (aUC) in the upper and lower urinary tract receiving immune checkpoint inhibitors (ICIs). PATIENTS AND METHODS We performed a retrospective cohort study collecting clinicopathological, treatment, and outcome data for patients with aUC receiving ICIs from 2013 to 2020 across 24 institutions. We compared the objective response rate (ORR), overall survival (OS), and progression-free survival (PFS) between patients with upper and lower tract UC (UTUC, LTUC). Uni- and multivariable logistic and Cox regression were used to assess the effect of UTUC on ORR, OS, and PFS. Subgroup analyses were performed stratified based on histology (pure, mixed) and line of treatment (first line, subsequent line). RESULTS Out of a total of 746 eligible patients, 707, 717, and 738 were included in the ORR, OS, and PFS analyses, respectively. Our results did not contradict the hypothesis that patients with UTUC and LTUC had similar ORRs (24% vs 28%; adjusted odds ratio [aOR] 0.73, 95% confidence interval [CI] 0.43-1.24), OS (median 9.8 vs 9.6 months; adjusted hazard ratio [aHR] 0.93, 95% CI 0.73-1.19), and PFS (median 4.3 vs 4.1 months; aHR 1.01, 95% CI 0.81-1.27). Patients with mixed-histology UTUC had a significantly lower ORR and shorter PFS vs mixed-histology LTUC (aOR 0.20, 95% CI 0.05-0.91 and aHR 1.66, 95% CI 1.06-2.59), respectively). CONCLUSION Overall, patients with UTUC and LTUC receiving ICIs have comparable treatment response and outcomes. Subgroup analyses based on histology showed that those with mixed-histology UTUC had a lower ORR and shorter PFS compared to mixed-histology LTUC. Further studies and evaluation of molecular biomarkers can help refine patient selection for immunotherapy.
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Affiliation(s)
- Stepan M Esagian
- Faculty of Medicine, School of Health Sciences, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ali Raza Khaki
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - 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, USA
| | - Joseph J Park
- Division of Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ajjai Alva
- Division of Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mehmet A Bilen
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Tyler F Stewart
- Division of Hematology/Oncology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Rana R McKay
- Division of Hematology/Oncology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Victor S Santos
- Division of Oncology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Neeraj Agarwal
- Division of Oncology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jayanshu Jain
- Department of Medicine, University of Iowa, Iowa City, IA, USA
| | - Yousef Zakharia
- Division of Oncology, Department of Medicine, University of Iowa, Iowa City, IA, USA
| | - 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, USA
| | - Ariel Nelson
- Division of Medical Oncology, Seidman Cancer Center at Case Comprehensive Cancer Center, Cleveland, OH, USA
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christopher J Hoimes
- Division of Medical Oncology, Seidman Cancer Center at Case Comprehensive Cancer Center, Cleveland, OH, USA
- Division of Medical Oncology, Duke University, Durham, NC, USA
| | - Evan Shreck
- Department of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Benjamin A Gartrell
- Department of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Alex Sankin
- Department of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Abhishek Tripathi
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Roubini Zakopoulou
- Department of Clinical Therapeutics, School of Medicine, Alexandra General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aristotelis Bamias
- 2nd Propaedeutic Dept of Internal Medicine, School of Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - 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, USA
| | - Sandy Liu
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Vivek Kumar
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark P Lythgoe
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jure Murgic
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Ana Fröbe
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
- School of Dental Medicine, Zagreb, Croatia
| | - Monika Joshi
- Division of Hematology/Oncology, Department of Medicine, Penn State Cancer Institute, Hershey, PA, USA
| | - Pedro Isaacsson Velho
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Noah Hahn
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | | | - 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, USA
| | - Pedro Barata
- Deming Department of Medicine, Section of Hematology/Oncology, Tulane University, New Orleans, LA, USA
| | - Matthew D Galsky
- Division of Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Guru Sonpavde
- Genitourinary Oncology Program, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Evan Y Yu
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Pavlos Msaouel
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vadim S Koshkin
- Division of Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Petros Grivas
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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14
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Khaki AR, Li A, Diamantopoulos LN, Miller NJ, Carril-Ajuria L, Castellano D, De Kouchkovsky I, Koshkin V, Park J, Alva A, Bilen MA, Stewart T, Santos V, Agarwal N, Jain J, Zakharia Y, Morales-Barrera R, Devitt M, Nelson A, Hoimes CJ, Shreck E, Gartrell BA, Sankin A, Tripathi A, Zakopoulou R, Bamias A, Rodriguez-Vida A, Drakaki A, Liu S, Kumar V, Lythgoe MP, Pinato DJ, Murgic J, Fröbe A, Joshi M, Isaacsson Velho P, Hahn N, Alonso Buznego L, Duran I, Moses M, Barata P, Galsky MD, Sonpavde G, Yu EY, Shankaran V, Lyman GH, Grivas P. A New Prognostic Model in Patients with Advanced Urothelial Carcinoma Treated with First-line Immune Checkpoint Inhibitors. Eur Urol Oncol 2021; 4:464-472. [PMID: 33423945 PMCID: PMC8169524 DOI: 10.1016/j.euo.2020.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/25/2020] [Accepted: 12/03/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND While immune checkpoint inhibitors (ICIs) are approved in the first-line (1L) setting for cisplatin-unfit patients with programmed death-ligand 1 (PD-L1)-high tumors or for platinum (cisplatin/carboplatin)-unfit patients, response rates remain modest and outcomes vary with no clinically useful biomarkers (except for PD-L1). OBJECTIVE We aimed to develop a prognostic model for overall survival (OS) in patients receiving 1L ICIs for advanced urothelial cancer (aUC) in a multicenter cohort study. DESIGN, SETTING, AND PARTICIPANTS Patients treated with 1L ICIs for aUC across 24 institutions and five countries (in the USA and Europe) outside clinical trials were included in this study. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We used a stepwise, hypothesis-driven approach using clinician-selected covariates to develop a new risk score for patients receiving ICIs in the 1L setting. Demographics, clinicopathologic data, treatment patterns, and OS were collected uniformly. Univariate Cox regression was performed on 18 covariates hypothesized to be associated with OS based on published data. Variables were retained for multivariate analysis (MVA) if they correlated with OS (p < 0.2) and were included in the final model if p < 0.05 on MVA. Retained covariates were assigned points based on the beta coefficient to create a risk score. Stratified median OS and C-statistic were calculated. RESULTS AND LIMITATIONS Among 984 patients, 357 with a mean age of 71 yr were included in the analysis, 27% were female, 68% had pure UC, and 13% had upper tract UC. Eastern Cooperative Oncology Group performance status ≥2, albumin <3.5 g/dl, neutrophil:lymphocyte ratio >5, and liver metastases were significant prognostic factors on MVA and were included in the risk score. C index for new 1L risk score was 0.68 (95% confidence interval 0.65-0.71). Limitations include retrospective nature and lack of external validation. CONCLUSIONS We developed a new 1L ICI risk score for OS based on data from patients with aUC treated with ICIs in the USA and Europe outside of clinical trials. The score components highlight readily available factors related to tumor biology and treatment response. External validation is being pursued. PATIENT SUMMARY With multiple new treatments under development and approved for advanced urothelial carcinoma, it can be difficult to identify the best treatment sequence for each patient. The risk score may help inform treatment discussions and estimate outcomes in patients treated with first-line immune checkpoint inhibitors, while it can also impact clinical trial design and endpoints. TAKE HOME MESSAGE: A new risk score was developed for advanced urothelial carcinoma treated with first-line immune checkpoint inhibitors. The score assigned Eastern Cooperative Oncology Group performance status ≥2, albumin <3.5 g/dl, neutrophil:lymphocyte ratio >5, and liver metastases each one point, with a higher score being associated with worse overall survival.
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Affiliation(s)
- Ali Raza Khaki
- Division of Medical Oncology, Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
| | - Ang Li
- Section of Hematology/Oncology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Natalie J Miller
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Ivan De Kouchkovsky
- Division of Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Vadim Koshkin
- Division of Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Joseph Park
- Division of Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ajjai Alva
- Division of Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mehmet A Bilen
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Tyler Stewart
- Division of Oncology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Victor Santos
- Division of Oncology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Neeraj Agarwal
- Division of Oncology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jayanshu Jain
- Department of Medicine, University of Iowa, Iowa City, IA, USA
| | - Yousef Zakharia
- Division of Oncology, Department of Medicine, University of Iowa, Iowa City, IA, USA
| | - Rafael Morales-Barrera
- Vall d'Hebron Institute of Oncology, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Michael Devitt
- Division of Hematology/Oncology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ariel Nelson
- Division of Medical Oncology, Seidman Cancer Center at Case Comprehensive Cancer Center, Cleveland, OH, USA; Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christopher J Hoimes
- Division of Medical Oncology, Seidman Cancer Center at Case Comprehensive Cancer Center, Cleveland, OH, USA; Division of Medical Oncology, Duke University, Durham, NC, USA
| | - Evan Shreck
- Departments of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Benjamin A Gartrell
- Departments of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Alex Sankin
- Departments of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Abhishek Tripathi
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Roubini Zakopoulou
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Aristotelis Bamias
- 2nd Propaedeutic Department of Internal Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - 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, USA
| | - Sandy Liu
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Vivek Kumar
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark P Lythgoe
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jure Murgic
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, School of Dental Medicine, Zagreb, Croatia
| | - Ana Fröbe
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, School of Dental Medicine, Zagreb, Croatia
| | - Monika Joshi
- Division of Hematology/Oncology, Department of Medicine, Penn State Cancer Institute, Hershey, PA, USA
| | - Pedro Isaacsson Velho
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Noah Hahn
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | | | - Ignacio Duran
- Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Marcus Moses
- Department of Medicine, Section of Hematology/Oncology, Tulane University, New Orleans, LA, USA
| | - Pedro Barata
- Department of Medicine, Section of Hematology/Oncology, Tulane University, New Orleans, LA, USA
| | - Matthew D Galsky
- Division of Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Guru Sonpavde
- Genitourinary Oncology Program, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Evan Y Yu
- Division of Medical Oncology, Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
| | - Veena Shankaran
- Division of Medical Oncology, Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
| | - Gary H Lyman
- Division of Medical Oncology, Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
| | - Petros Grivas
- Division of Medical Oncology, Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA.
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15
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Ravi P, Pond GR, Diamantopoulos LN, Su C, Alva A, Jain RK, Skelton WP, Gupta S, Tward JD, Olson KM, Singh P, Grunewald CM, Niegisch G, Lee JL, Gallina A, Bandini M, Necchi A, Mossanen M, McGregor BA, Curran C, Grivas P, Sonpavde GP. Optimal pathological response after neoadjuvant chemotherapy for muscle-invasive bladder cancer: results from a global, multicentre collaboration. BJU Int 2021; 128:607-614. [PMID: 33909949 DOI: 10.1111/bju.15434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate outcomes of patients achieving a post-treatment pathological stage of <ypT2N0 at radical cystectomy (RC) following neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) to identify an optimal definition of pathological response. PATIENTS AND METHODS Patients from 10 international centres who underwent NAC for cT2-4aN0-1 MIBC and achieved <ypT2N0 disease at RC were included. The primary outcome was time to recurrence, either local or distant. Kaplan-Meier and Cox proportional hazards regression were used to evaluate associations between clinicopathological variables and outcomes. RESULTS A total of 625 patients were included. The median age was 66 years and 80% were male. Gemcitabine and cisplatin (GC, 56%) and methotrexate, vinblastine, doxorubicin and cisplatin (MVAC)/dose-dense (dd)MVAC (32%) were the most common NAC regimens. ypT0, pure ypTis, ypTa ±ypTis and ypT1 ± ypTis were attained in 58.1%, 20.0%, 7.6% and 14.2% of patients, respectively. The cumulative incidence of recurrence at 5 years was 9%, 16%, 29% and 30%, respectively. Pathological stage was prognostic for recurrence, with ypTa ± Tis (hazard ratio [HR] 3.20, 95% confidence interval [CI] 1.40-7.30) and ypT1 ± Tis disease (HR 4.03, 95% CI 2.13-7.63) associated with a significantly higher recurrence risk. Pure ypTis (HR 1.66, 95% CI 0.82-3.38) and the type of NAC regimen (ddMVAC: HR 1.59, 95% CI 0.55-4.56; MVAC: HR 1.18, 9%% CI 0.25-5.54; reference: GC) were not associated with recurrence. CONCLUSION We propose that optimal pathological response after NAC be defined as attainment of ypT0N0/ypTisN0 at RC. Patients with ypTaN0 or ypT1N0 disease (with or without Tis) at RC displayed a significantly higher risk of recurrence and may be candidates for trials investigating adjuvant therapy.
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Affiliation(s)
- Praful Ravi
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Leonidas N Diamantopoulos
- Fred Hutchinson Cancer Research Center Seattle, University of Washington, Seattle, WA, USA.,University of Pittsburg Medical Center, Pittsburgh, PA, USA
| | | | - Ajjai Alva
- University of Michigan, Ann Arbor, MI, USA
| | | | | | - Sumati Gupta
- University of Utah's Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Jonathan D Tward
- University of Utah's Huntsman Cancer Institute, Salt Lake City, UT, USA
| | | | | | - Camilla M Grunewald
- Department of Urology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Guenter Niegisch
- Department of Urology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Jae-Lyun Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Matthew Mossanen
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Petros Grivas
- Fred Hutchinson Cancer Research Center Seattle, University of Washington, Seattle, WA, USA
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Nelson AA, Cronk RJ, Lemke EA, Szabo A, Khaki AR, Diamantopoulos LN, Grivas P, Nezami BG, MacLennan GT, Zhang T, Hoimes CJ. Early Bone Metastases are Associated with Worse Outcomes in Metastatic Urothelial Carcinoma. Bladder Cancer 2021. [DOI: 10.3233/blc-200377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Outcomes of patients with metastatic urothelial carcinoma (mUC) with early bone metastases (eBM) vs no early bone metastases (nBM) have not thoroughly been described in the age of immuno-oncology. OBJECTIVE: To compare survival and other clinical outcomes in patients with eBM and nBM. METHODS: We used a multi-institutional database of patients with mUC treated with systemic therapy. Demographic, metastatic site, treatment patterns, and clinical outcomes were recorded. Wilcoxon rank-sum, chi-square tests were performed. Survival was estimated by Kaplan-Meier method; multivariable Cox analysis was performed. RESULTS: We identified 270 pts, 67% men, mean age 69±11 years. At metastatic diagnosis, 27% had≥1 eBM and were more likely to have de novo vs. recurrent metastases (42% vs 19%, p < 0.001). Patients with eBM had shorter overall survival (OS) vs. those with nBM, (6.1 vs 13.7 months, p < 0.0001). On multivariable analysis, eBM independently associated with higher risk of death, HR = 2.52 (95% CI: 1.75–3.63, p < 0.0001). OS was shorter for patients with eBM who received initial immune checkpoint inhibitor vs platinum-based chemotherapy, (1.6 vs 9.1 months, p = 0.02). Patients with eBM received higher opioid analgesic doses compared to patients with nBM and received quantitatively more palliative radiation. CONCLUSIONS: Patients with mUC and eBM have poorer outcomes, may benefit less from anti-PD-1/PD-L1 therapy and represent an unmet need for novel therapeutic interventions. Dedicated clinical trials, biomarker validation to assist in patient selection, as well as consensus on reporting of non-measurable disease are required.
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Affiliation(s)
- Ariel A. Nelson
- Division of Hematology & Oncology, Department of Medicine, The Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Medical Oncology, Seidman Cancer Center at Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Robert J. Cronk
- Division of Hematology & Oncology, Department of Medicine, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Emily A. Lemke
- Division of Hematology & Oncology, Department of Medicine, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aniko Szabo
- Division of Biostatistics, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ali R. Khaki
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Leonidas N. Diamantopoulos
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Petros Grivas
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Behtash Ghazi Nezami
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Gregory T. MacLennan
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Tian Zhang
- Division of Medical Oncology, Department of Medicine, Duke University, Durham, NC, USA
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA
| | - Christopher J. Hoimes
- Division of Medical Oncology, Seidman Cancer Center at Case Comprehensive Cancer Center, Cleveland, OH, USA
- Division of Medical Oncology, Department of Medicine, Duke University, Durham, NC, USA
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA
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17
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Diamantopoulos LN, Holt SK, Khaki AR, Sekar RR, Gadzinski A, Nyame YA, Vakar-Lopez F, Tretiakova MS, Psutka SP, Gore JL, Lin DW, Schade GR, Hsieh AC, Lee JK, Yezefski T, Schweizer MT, Cheng HH, Yu EY, True LD, Montgomery RB, Grivas P, Wright JL. Response to Neoadjuvant Chemotherapy and Survival in Micropapillary Urothelial Carcinoma: Data From a Tertiary Referral Center and the Surveillance, Epidemiology, and End Results (SEER) Program. Clin Genitourin Cancer 2020; 19:144-154. [PMID: 33160889 DOI: 10.1016/j.clgc.2020.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Micropapillary urothelial carcinoma (MPC) is a rare urothelial carcinoma variant with conflicting data guiding clinical practice. In this study, we explored oncologic outcomes in relation to neoadjuvant chemotherapy (NAC) in a retrospective cohort of patients with MPC, alongside data from Surveillance, Epidemiology, and End Results (SEER)-Medicare. PATIENTS AND METHODS We retrospectively identified patients with MPC or conventional urothelial carcinoma (CUC) without any variant histology undergoing radical cystectomy (RC) in our institution (2003-2018). SEER-Medicare was also queried to identify patients diagnosed with MPC (2004-2015). Clinicopathologic data and treatment modalities were extracted. Overall survival (OS) was estimated with the Kaplan-Meier method. Mann-Whitney-Wilcoxon and chi-square tests were used for comparative analysis and Cox regression for identifying clinical covariates associated with OS. RESULTS Our institutional database yielded 46 patients with MPC and 457 with CUC. In SEER-Medicare, 183 patients with MPC were identified, and 63 (34%) underwent RC. In the institutional cohort, patients with MPC had significantly higher incidence of cN+ (17% vs. 8%), pN+ stage (30% vs. 17%), carcinoma-in-situ (43% vs. 25%), and lymphovascular invasion (30% vs. 16%) at RC versus those with CUC (all P < .05). Pathologic complete response (ypT0N0) to NAC was 33% for MPC and 35% for CUC (P = .899). Median OS was lower for institutional MPC versus CUC in univariate analysis (43.6 vs. 105.3 months, P = .006); however, MPC was not independently associated with OS in the multivariate model. Median OS was 25 months in the SEER MPC cohort for patients undergoing RC, while NAC was not associated with improved OS in that group. CONCLUSION Pathologic response to NAC was not significantly different between MPC and CUC, while MPC histology was not an independent predictor of OS. Further studies are needed to better understand biological mechanisms behind its aggressive features as well as the role of NAC in this histology variant.
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Affiliation(s)
- Leonidas N Diamantopoulos
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | - Sarah K Holt
- Department of Urology, University of Washington, Seattle, WA
| | - Ali R Khaki
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | - Rishi R Sekar
- Department of Urology, University of Washington, Seattle, WA
| | - Adam Gadzinski
- Department of Urology, University of Washington, Seattle, WA
| | - Yaw A Nyame
- Department of Urology, University of Washington, Seattle, WA
| | | | | | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA
| | - John L Gore
- Department of Urology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Daniel W Lin
- Department of Urology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - George R Schade
- Department of Urology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Andrew C Hsieh
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - John K Lee
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Todd Yezefski
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | - Michael T Schweizer
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Heather H Cheng
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Evan Y Yu
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Lawrence D True
- Department of Pathology, University of Washington, Seattle, WA
| | - Robert B Montgomery
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Petros Grivas
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA.
| | - Jonathan L Wright
- Department of Urology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA.
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Diamantopoulos LN, Khaki AR, Sonpavde GP, Venur VA, Yu EY, Wright JL, Grivas P. Central Nervous System Metastasis in Patients With Urothelial Carcinoma: Institutional Experience and a Comprehensive Review of the Literature. Clin Genitourin Cancer 2020; 18:e266-e276. [PMID: 32178979 PMCID: PMC7272305 DOI: 10.1016/j.clgc.2019.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 11/05/2019] [Accepted: 11/27/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Central nervous system (CNS) metastasis in patients with urothelial carcinoma (UC) is uncommon and poorly understood. We aimed to explore the clinical behavior and outcomes of this unique patient population. MATERIALS AND METHODS We performed a retrospective analysis of patients with UC and CNS metastasis, treated in our institution (2006-2018), along with an exploratory patient-point meta-analysis of a similar patient population derived from a comprehensive literature review. Data regarding diagnosis, management, and outcomes were extracted. Overall survival, time to CNS metastasis (TTCM), and residual survival (RS) from CNS involvement to death were calculated (Kaplan-Meier method). Cox regression was used for testing key clinicopathologic associations. RESULTS We identified 20 "institutional" and 154 "literature" patients with adequate data granularity for analysis. Median TTCM was 17.7 (institutional cohort) and 10 (literature cohort) months. Most patients who developed CNS metastases had previous non-CNS metastasis (15/20 [75%] and 103/154 [67%], respectively). CNS lesions without previous history of metastasis were identified in 5/20 (25%) and 33/154 (21%) cases and those patients had a shorter TTCM. CNS lesions in the absence of known UC history were also documented in 18/154 (12%) literature cases. Multifocal CNS disease was associated with shorter RS in both cohorts in univariate, but not multivariate, analysis. CONCLUSION We observed a variability in disease presentation and course, with a subset of patients showing an early predilection for CNS insult, potentially reflecting a diverse underlying biology. Genomic profiling studies, elucidating the molecular landscape, and driving future treatments should be considered in this setting.
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Affiliation(s)
- Leonidas N Diamantopoulos
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ali R Khaki
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Guru P Sonpavde
- Division of Genitourinary Oncology, Dana Farber Cancer Institute, Boston, MA
| | - Vyshak A Venur
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Evan Y Yu
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Petros Grivas
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center, Seattle, WA.
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Diamantopoulos LN, Khaki AR, Grivas P, Gore JL, Schade GR, Hsieh AC, Lee JK, Yezefski T, Yu EY, Schweizer MT, Cheng HH, Psutka SP, Lin DW, Tretiakova MS, Vakar-Lopez F, Montgomery RB, Wright JL. Plasmacytoid urothelial carcinoma: response to chemotherapy and oncologic outcomes. Bladder Cancer 2020; 6:71-81. [PMID: 34109262 DOI: 10.3233/blc-190258] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Plasmacytoid urothelial carcinoma is a rare bladder cancer variant with scarce data on outcomes and prognostic factors. OBJECTIVE We report our institutional experience with this histology to determine response to neoadjuvant chemotherapy, definitive surgery and survival. METHODS We conducted a retrospective chart review of consecutive patients with plasmacytoid, as well as conventional urothelial carcinoma (for comparison) seen in our institution (2007 - 2018). Baseline characteristics, clinicopathologic and treatment data were captured. T-test, chi-squared and log-rank test was used for group comparison. Kaplan Meier method was used for estimation of overall survival and Cox regression for identification of prognostic factors. RESULTS 64 patients with plasmacytoid and 418 with conventional urothelial histology were identified; 53% of those with plasmacytoid presented with cT3/4 stage and 67% underwent extirpative surgery. Patients with plasmacytoid histology had higher rates of pT3/4 (65% vs. 28%), nodal disease (37% vs. 16%) and positive surgical margins (23% vs. 5%) compared to urothelial group (p < 0.01), as well as higher incidence of post-operative recurrence (47% vs. 29%, p = 0.05) and lower ypT0N0 rates after neoadjuvant chemotherapy (10% vs. 33%, p = 0.03). Plasmacytoid histology was associated with lower median overall survival compared to conventional urothelial (24 vs. 154 months, p < 0.01). CONCLUSIONS Plasmacytoid urothelial carcinoma frequently presented with advanced stage at diagnosis and extirpative surgery, poor pathologic response to neoadjuvant chemotherapy, and inferior outcomes, when compared to conventional urothelial. Prospective trials evaluating upfront cystectomy versus preoperative chemotherapy and/or novel treatments should be considered.
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Affiliation(s)
- Leonidas N Diamantopoulos
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA
| | - Ali Raza Khaki
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA
| | - Petros Grivas
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - John L Gore
- Department of Urology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - George R Schade
- Department of Urology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Andrew C Hsieh
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - John K Lee
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Todd Yezefski
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA
| | - Evan Y Yu
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Michael T Schweizer
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Heather H Cheng
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Sarah P Psutka
- Department of Urology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Daniel W Lin
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA.,Department of Urology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Maria S Tretiakova
- Department of Pathology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Funda Vakar-Lopez
- Department of Pathology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Robert B Montgomery
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Jonathan L Wright
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA.,Department of Urology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
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Khaki AR, Li A, Diamantopoulos LN, Bilen MA, Santos V, Esther J, Morales-Barrera R, Devitt M, Nelson A, Hoimes CJ, Shreck E, Assi H, Gartrell BA, Sankin A, Rodriguez-Vida A, Lythgoe M, Pinato DJ, Drakaki A, Joshi M, Velho PI, Hahn N, Liu S, Buznego LA, Duran I, Moses M, Jain J, Murgic J, Baratam P, Barata P, Tripathi A, Zakharia Y, Galsky MD, Sonpavde G, Yu EY, Shankaran V, Lyman GH, Grivas P. Impact of performance status on treatment outcomes: A real-world study of advanced urothelial cancer treated with immune checkpoint inhibitors. Cancer 2020; 126:1208-1216. [PMID: 31829450 PMCID: PMC7050422 DOI: 10.1002/cncr.32645] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/07/2019] [Accepted: 10/27/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) represent an appealing treatment for patients with advanced urothelial cancer (aUC) and a poor performance status (PS). However, the benefit of ICIs for patients with a poor PS remains unknown. It was hypothesized that a poor Eastern Cooperative Oncology Group (ECOG) PS (≥2 vs 0-1) would correlate with shorter overall survival (OS) in patients receiving ICIs. METHODS In this retrospective cohort study, clinicopathologic, treatment, and outcome data were collected for patients with aUC who were treated with ICIs at 18 institutions (2013-2019). The overall response rate (ORR) and OS were compared for patients with an ECOG PS of 0 to 1 and patients with an ECOG PS ≥ 2 at ICI initiation. The association between a new ICI in the last 30 and 90 days of life (DOL) and death location was also tested. RESULTS Of the 519 patients treated with ICIs, 395 and 384 were included in OS and ORR analyses, respectively, with 26% and 24% having a PS ≥ 2. OS was higher in those with a PS of 0 to 1 than those with a PS ≥ 2 who were treated in the first line (median, 15.2 vs 7.2 months; hazard ratio [HR], 0.62; P = .01) but not in subsequent lines (median, 9.8 vs 8.2 months; HR, 0.78; P = .27). ORRs were similar for patients with a PS of 0 to 1 and patients with a PS ≥ 2 in both lines. Of the 288 patients who died, 10% and 32% started ICIs in the last 30 and 90 DOL, respectively. ICI initiation in the last 30 DOL was associated with increased odds of death in a hospital (odds ratio, 2.89; P = .04). CONCLUSIONS Despite comparable ORRs, ICIs may not overcome the negative prognostic role of a poor PS, particularly in the first-line setting, and the initiation of ICIs in the last 30 DOL was associated with hospital death location.
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Affiliation(s)
- Ali Raza Khaki
- Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ang Li
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Mehmet A. Bilen
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Victor Santos
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - John Esther
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Rafael Morales-Barrera
- Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Michael Devitt
- Division of Hematology/Oncology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Ariel Nelson
- Division of Hematology/Oncology, Department of Medicine, Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Christopher J Hoimes
- Division of Hematology/Oncology, Department of Medicine, Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Evan Shreck
- Departments of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Hussein Assi
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Benjamin A Gartrell
- Departments of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Alex Sankin
- Departments of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Alejo Rodriguez-Vida
- Medical Oncology Department, Hospital del Mar Research Institute, Barcelona, Spain
| | - Mark Lythgoe
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - David J. Pinato
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alexandra Drakaki
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Monika Joshi
- Division of Hematology/Oncology, Department of Medicine, Penn State Cancer Institute, Hershey, PA, USA
| | - Pedro Isaacsson Velho
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Noah Hahn
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Sandy Liu
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Ignacio Duran
- Hospital Universitario Marques de Valdecilla. IDIVAL. Santander, Spain
| | - Marcus Moses
- Department of Medicine and Oncology, Tulane University, New Orleans, LA, USA
| | - Jayanshu Jain
- Department of Medicine, University of Iowa, Iowa City, IA, USA
| | - Jure Murgic
- Department of Oncology and Nuclear Medicine, University Hospital Center Sisters of Charity Zagreb School of Medicine, Zagreb, Croatia
| | | | - Pedro Barata
- Department of Medicine and Oncology, Tulane University, New Orleans, LA, USA
| | - Abhishek Tripathi
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Yousef Zakharia
- Division of Oncology, Department of Medicine, University of Iowa, Iowa City, IA, USA
| | - Matthew D. Galsky
- Division of Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Guru Sonpavde
- Genitourinary Oncology Program, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Evan Y Yu
- Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Veena Shankaran
- Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Gary H Lyman
- Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Petros Grivas
- Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
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Diamantopoulos LN, Winters BR, Grivas P, Ngo SD, Zeng J, Hsieh AC, Gore JL, Liao JJ, Yu EY, Schade GR, Psutka SP, Schweizer MT, Lee JH, Dighe M, Lin DW, Cheng HH, Daya J, Tretiakova MS, True LD, Russell KJ, Vakar-Lopez F, Montgomery RB, Wright JL. Bladder Cancer Multidisciplinary Clinic (BCMC) Model Influences Disease Assessment and Impacts Treatment Recommendations. Bladder Cancer 2019. [DOI: 10.3233/blc-190239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Leonidas N. Diamantopoulos
- Department of Medicine, Division of Oncology, University of Washington School of Medicine, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Brian R. Winters
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Petros Grivas
- Department of Medicine, Division of Oncology, University of Washington School of Medicine, Seattle Cancer Care Alliance, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Steven D. Ngo
- University of Washington School of Medicine, Seattle, WA, USA
| | - Jing Zeng
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Andrew C. Hsieh
- Department of Medicine, Division of Oncology, University of Washington School of Medicine, Seattle Cancer Care Alliance, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - John L. Gore
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Jay J. Liao
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Evan Y. Yu
- Department of Medicine, Division of Oncology, University of Washington School of Medicine, Seattle Cancer Care Alliance, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - George R. Schade
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sarah P. Psutka
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Michael T. Schweizer
- Department of Medicine, Division of Oncology, University of Washington School of Medicine, Seattle Cancer Care Alliance, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jean H. Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Manjiri Dighe
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Daniel W. Lin
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Heather H. Cheng
- Department of Medicine, Division of Oncology, University of Washington School of Medicine, Seattle Cancer Care Alliance, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Joanna Daya
- University of Washington School of Medicine, Seattle, WA, USA
| | - Maria S. Tretiakova
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Lawrence D. True
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Kenneth J. Russell
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Funda Vakar-Lopez
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Robert B. Montgomery
- Department of Medicine, Division of Oncology, University of Washington School of Medicine, Seattle Cancer Care Alliance, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jonathan L. Wright
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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