Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Eur Urol Oncol. 2021 Aug;4(4):659-662. doi: 10.1016/j.euo.2019.03.001. Epub 2019 Apr 9.
There are few data on outcomes for patients with metastatic urothelial carcinoma (MUC) who receive chemotherapy (CT) after progression on immune checkpoint inhibitors (ICIs). We carried out a retrospective single-centre analysis of MUC patients who progressed after ICI and then received CT. Patients fell into two groups: CT-naive (no prior-CT) and CT-pretreated (platinum-based CT followed by ICI on progression). The response rate (RR), progression-free survival (PFS), and duration of response (DOR) were assessed. A total of 29 patients received CT following progression on ICI. The median follow-up was 17.0mo (interquartile range 9.1-20.5mo). In the CT-naive group (n=17), 53% had a partial response, 18% had stable disease, and 29% had progressive disease. In the CT-pretreated group (n=12) 17% had a partial response, 67% had stable disease, and 16% had progressive disease. The median PFS was 6.4mo (95% confidence interval [CI] 3.8-9.1) in the CT-naive and 4.4mo (95% CI 1.5-7.3) in the CT-pretreated group. The median DOR was 8.1mo (range 5.1-11.1) among the ten patients with a response to CT after ICI in both groups. Some 38% of patients in the CT-naive and 17% in the CT-pretreated group had dose reductions on post-ICI CT. CT and ICI can be sequenced after previous chemotherapy exposure, although this does not induce long-term durable remissions in most patients. PATIENT SUMMARY: We looked at outcomes for patients with metastatic bladder cancer who received chemotherapy after the cancer got worse while on immunotherapy. We found that patients can be safely treated with further chemotherapy. However, the positive effects of chemotherapy will not be durable in the majority of patients.
在免疫检查点抑制剂 (ICI) 进展后接受化疗 (CT) 的转移性尿路上皮癌 (MUC) 患者的结局数据很少。我们对 ICI 进展后接受 CT 的 MUC 患者进行了回顾性单中心分析。患者分为两组：CT 初治组（无 CT 治疗史）和 CT 预处理组（顺铂 CT 后进展时接受 ICI）。评估了反应率 (RR)、无进展生存期 (PFS) 和缓解持续时间 (DOR)。共 29 例患者在 ICI 进展后接受 CT。中位随访时间为 17.0mo（四分位距 9.1-20.5mo）。在 CT 初治组（n=17）中，53%的患者有部分缓解，18%的患者有稳定的疾病，29%的患者有进展性疾病。在 CT 预处理组（n=12）中，17%的患者有部分缓解，67%的患者有稳定的疾病，16%的患者有进展性疾病。CT 初治组的中位 PFS 为 6.4mo（95%CI 3.8-9.1），CT 预处理组为 4.4mo（95%CI 1.5-7.3）。两组中 10 例 ICI 后对 CT 有反应的患者的中位 DOR 为 8.1mo（范围 5.1-11.1）。CT 初治组和 CT 预处理组中分别有 38%和 17%的患者在 ICI 后 CT 时减少了剂量。尽管在大多数患者中，这种治疗并不能诱导长期持久的缓解，但 CT 和 ICI 可以在先前的化疗暴露后进行序贯治疗。
