Department of Medicine, University of Washington, Seattle, Washington, USA.
Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Oncologist. 2021 Dec;26(12):1026-1034. doi: 10.1002/onco.13925. Epub 2021 Aug 17.
Fit patients with metastatic urothelial carcinoma (mUC) receive first-line platinum-based combination chemotherapy (fPBC) as standard of care and may receive additional later-line chemotherapy after progression. Our study compares outcomes with subsequent platinum-based chemotherapy (sPBC) versus subsequent non-platinum-based chemotherapy (sNPBC).
Patients from 27 international centers in the Retrospective International Study of Cancers of the Urothelium (RISC) who received fPBC for mUC and at least two cycles of subsequent chemotherapy were included in this study. A multivariable Cox proportional hazards model compared overall survival (OS) and progression-free survival (PFS).
One hundred thirty-five patients received sPBC and 161 received sNPBC. Baseline characteristics were similar between groups, except patients who received sPBC had higher baseline hemoglobin, higher disease control rate with fPBC, and longer time since fPBC. OS was superior in the sPBC group (median 7.9 vs 5.5 months) in a model adjusting for comorbidity burden, performance status, liver metastases, number of fPBC cycles received, best response to fPBC, and time since fPBC (hazard ratio, 0.72; 95% confidence interval, 0.53-0.98; p = .035). There was no difference in PFS. More patients in the sPBC group achieved disease control than in the sNPBC group (57.4% vs 44.8%; p = .041). Factors associated with achieving disease control in the sPBC group but not the sNPBC group included longer time since fPBC, achieving disease control with fPBC, and absence of liver metastases.
After receiving fPBC for mUC, patients who received sPBC had better OS and disease control. This may help inform the choice of subsequent chemotherapy in patients with mUC.
Patients with progressive metastatic urothelial carcinoma after first-line platinum-based combination chemotherapy may now receive immuno-oncology agents, erdafitinib, enfortumab vedotin, or sacituzumab govitecan-hziy; however, those ineligible for these later-line therapies or who progress after receiving them may be considered for subsequent chemotherapy. In this retrospective study of 296 patients, survival outcomes and disease control rates were better in those receiving subsequent platinum-based rechallenge compared with non-platinum-based chemotherapy, suggesting that patients should receive platinum rechallenge if clinically able. Disease control with platinum rechallenge was more likely with prior first-line platinum having achieved disease control, longer time since first-line platinum, and absence of liver metastases.
适合接受转移性尿路上皮癌（mUC）一线铂类联合化疗（fPBC）的患者作为标准治疗，在进展后可能会接受额外的后续化疗。我们的研究比较了后续铂类化疗（sPBC）与后续非铂类化疗（sNPBC）的结果。
本研究纳入了来自国际Retrospective International Study of Cancers of the Urothelium（RISC）的 27 个国际中心的接受 mUC 一线 fPBC 治疗且至少接受两个周期后续化疗的患者。多变量 Cox 比例风险模型比较了总生存期（OS）和无进展生存期（PFS）。
135 例患者接受 sPBC，161 例患者接受 sNPBC。两组之间的基线特征相似，但接受 sPBC 的患者基线血红蛋白更高、fPBC 的疾病控制率更高、且距 fPBC 的时间更长。在调整合并症负担、表现状态、肝转移、接受 fPBC 的周期数、fPBC 最佳反应和距 fPBC 的时间后，sPBC 组的 OS 更优（中位 OS 7.9 个月 vs 5.5 个月）（风险比，0.72；95%置信区间，0.53-0.98；p=0.035）。两组间 PFS 无差异。sPBC 组疾病控制率高于 sNPBC 组（57.4% vs 44.8%；p=0.041）。在 sPBC 组但不在 sNPBC 组中与疾病控制相关的因素包括距 fPBC 的时间更长、fPBC 的疾病控制率以及无肝转移。
在接受 mUC 的一线铂类联合化疗后，接受 sPBC 的患者的 OS 和疾病控制率更好。这可能有助于为 mUC 患者提供后续化疗的选择。
接受一线铂类联合化疗后进展的转移性尿路上皮癌患者现在可以接受免疫肿瘤药物、erdafitinib、enfortumab vedotin 或 sacituzumab govitecan-hziy；然而，那些不符合这些后线治疗条件或在接受后进展的患者可能会考虑接受后续化疗。在这项对 296 名患者的回顾性研究中，与非铂类化疗相比，接受后续铂类再挑战的患者的生存结果和疾病控制率更好，这表明如果临床可行，患者应接受铂类再挑战。铂类再挑战的疾病控制率更高与一线铂类药物具有疾病控制率、距一线铂类药物的时间更长以及无肝转移有关。
