Department of Urology, University of Tübingen, Tübingen, Germany.
Department of Urology, Campus Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany.
Eur Urol Focus. 2021 Sep;7(5):1084-1091. doi: 10.1016/j.euf.2020.10.009. Epub 2020 Nov 6.
The value of a complete response to immune checkpoint inhibitor treatment for urothelial cancer is well recognised, but less is known about long-term outcomes in patients with a partial response or the benefit of achieving disease stabilisation.
To determine clinical outcomes in patients with a partial response or stable disease on atezolizumab therapy for advanced urinary tract carcinoma (UTC).
DESIGN, SETTING, AND PARTICIPANTS: Data were extracted from three prospective trials (IMvigor210 cohort 2, SAUL, and IMvigor211) evaluating single-agent atezolizumab therapy for platinum-pretreated advanced UTC. The analysis population included 604 atezolizumab-treated and 208 chemotherapy-treated patients (229 achieving a partial response and 583 achieving stable disease).
Atezolizumab 1200 mg every 3 wk until progression or unacceptable toxicity or single-agent chemotherapy for patients in the control arm of IMvigor211.
Baseline characteristics, treatment exposure, overall survival, duration of disease control. Partial response and stable disease populations were analysed separately.
The population of patients with a partial response included more patients with programmed cell death ligand 1 (PD-L1) expression on ≥5% of tumour-infiltrating immune cells than the stable disease population. The median time to best response was 2.1 mo across trials and treatments, regardless of the type of response. Atezolizumab-treated patients with a partial response had sustained disease control (median overall survival not reached); durations of disease control and overall survival were longer with atezolizumab than with chemotherapy. In patients with stable disease, median overall survival was numerically longer with atezolizumab (exceeding 1 yr) than with chemotherapy. Irrespective of treatment, durations of disease control and survival were shorter in patients with stable disease than in those achieving a partial response. These analyses are limited by their post hoc exploratory nature and relatively short follow-up.
Stable disease and partial response are meaningful clinical outcomes in atezolizumab-treated patients with advanced UTC.
In this report, we looked at the outcomes in patients whose tumours responded to treatment to some extent, but the tumour did not disappear completely. We aimed to understand whether a modest response to treatment was associated with meaningful long-term outcomes for patients. We found that on average, life expectancy was >1 yr in patients whose disease was stabilised and even longer in those whose tumours showed some shrinkage in response to treatment.
免疫检查点抑制剂治疗对尿路上皮癌的完全缓解的价值已得到充分认可，但对于部分缓解或疾病稳定患者的长期结果以及实现疾病稳定的获益了解较少。
确定在接受阿替利珠单抗治疗的晚期尿路上皮癌（UTC）患者中，部分缓解或疾病稳定患者的临床结局。
设计、地点和参与者：从三项评估单药阿替利珠单抗治疗铂预处理晚期 UTC 的前瞻性试验（IMvigor210 队列 2、SAUL 和 IMvigor211）中提取数据。分析人群包括 604 例接受阿替利珠单抗治疗和 208 例接受化疗治疗的患者（229 例部分缓解，583 例疾病稳定）。
阿替利珠单抗 1200 mg，每 3 周 1 次，直至进展或不可接受的毒性或 IMvigor211 对照臂中的单药化疗。
根据基线特征、治疗暴露、总生存期、疾病控制持续时间进行分析。分别对部分缓解和疾病稳定人群进行分析。
部分缓解人群中，肿瘤浸润免疫细胞中程序性死亡配体 1（PD-L1）表达≥5%的患者多于疾病稳定人群。无论反应类型如何，三项试验和治疗的最佳反应中位时间均为 2.1 个月。接受阿替利珠单抗治疗的部分缓解患者持续疾病控制（中位总生存期未达到）；与化疗相比，阿替利珠单抗的疾病控制持续时间和总生存期更长。在疾病稳定的患者中，与化疗相比，阿替利珠单抗的中位总生存期更长（超过 1 年）。无论治疗如何，疾病稳定患者的疾病控制和生存时间均短于部分缓解患者。这些分析受到其事后探索性本质和相对较短随访的限制。
阿替利珠单抗治疗晚期 UTC 患者中，疾病稳定和部分缓解是有意义的临床结局。
在本报告中，我们研究了那些肿瘤对治疗有一定反应但肿瘤未完全消失的患者的治疗结果。我们旨在了解治疗有一定反应是否与患者的长期获益相关。我们发现，疾病稳定患者的平均预期寿命>1 年，而肿瘤对治疗有部分缩小的患者的预期寿命更长。
