Barts Cancer Institute, Queen Mary University of London, London, UK; Department of Urology, University of Munich, Klinikum Grosshadern, Germany.
Netherlands Cancer Institute, Amsterdam, The Netherlands.
Eur Urol. 2018 Feb;73(2):149-152. doi: 10.1016/j.eururo.2017.08.022. Epub 2017 Sep 13.
Immune checkpoint inhibitors (ICIs) are active in metastatic urothelial carcinoma (MUC). They have joined chemotherapy (CT) as a standard of care. Here, we investigate the activity of CT after progression on ICIs. Two cohorts of sequential patients with MUC were described (n=28). Cohort A received first-line ICIs followed by CT after progression. Cohort B received CT after failure of first-line platinum-based CT followed by ICIs. Response rate (RR) to CT was assessed using Response Evaluation Criteria in Solid Tumors (RECIST v1.1) by a designated radiologist. Best RR for cohort A was 64%. Two patients experienced clinical progression and died before the first radiographic assessment. RR for cohort B was 21%, which was significantly lower than that for cohort A. Progression of disease occurred in 43% of cohort B patients by the end of CT. These data suggest a lack of cross resistance between CT and ICIs in MUC. Therefore, the sequencing of these drugs is likely to be important to maximise outcomes. This is particularly true after first-line ICIs as subsequent CT has significant activity.
In this report, we studied the effect of chemotherapy in metastatic bladder cancer, which relapsed after immune checkpoint inhibitors. We found that the activity of chemotherapy was maintained despite previous exposure to immune therapy. This underlines the importance of sequencing these agents to maximise outcomes.
免疫检查点抑制剂（ICI）在转移性尿路上皮癌（MUC）中具有活性。它们已与化疗（CT）一起成为标准治疗方法。在这里，我们研究了 ICI 进展后 CT 的活性。描述了两个连续的 MUC 患者队列（n=28）。队列 A 接受一线 ICI 治疗，然后在进展后接受 CT。队列 B 在一线铂类 CT 失败后接受 CT，然后接受 ICI。指定的放射科医生使用实体瘤反应评估标准（RECIST v1.1）评估 CT 的缓解率（RR）。队列 A 的最佳 RR 为 64%。有 2 名患者在首次影像学评估前因疾病进展和死亡。队列 B 的 RR 为 21%，明显低于队列 A。到 CT 结束时，队列 B 的 43%患者疾病进展。这些数据表明在 MUC 中 CT 和 ICI 之间缺乏交叉耐药性。因此，这些药物的序贯使用很可能对最大限度地提高疗效很重要。这在一线 ICI 后尤其如此，因为随后的 CT 具有显著的活性。
在本报告中，我们研究了化疗在免疫检查点抑制剂治疗后复发的转移性膀胱癌中的作用。我们发现，尽管先前接受过免疫治疗，但化疗的活性仍得以维持。这强调了为了最大限度地提高疗效而对这些药物进行排序的重要性。
