Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Urology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.
Int J Urol. 2024 May;31(5):552-559. doi: 10.1111/iju.15411. Epub 2024 Feb 1.
Immune checkpoint inhibitors and enfortumab vedotin have opened new avenues for sequential treatment strategies for locally advanced/metastatic urothelial carcinoma (la/mUC). In the pre-enfortumab vedotin era, many patients could not receive third-line treatment owing to rapid disease progression and poor general status. This study aimed to analyze real-world sequential treatment practices for la/mUC in Japan, with a focus on patients who do not receive third-line treatment.
We analyzed data for 1023 la/mUC patients diagnosed between January 2020 and December 2021 at 54 institutions from a Japanese nationwide cohort.
At the median follow-up of 28.5 months, the median overall survival from first-line initiation for 905 patients who received systemic anticancer treatment was 19.1 months. Among them, 81% and 32% received second- and third-line treatment. Notably, 52% had their treatment terminated before the opportunity for third-line treatment. Multivariate logistic regression analysis revealed that low performance status (≥1), elevated neutrophil-to-lymphocyte ratio (≥3), and low body mass index (<21 kg/m) at the start of first-line treatment were independent risk factors for not proceeding to third-line treatment (p = 0.0024, 0.0069, and 0.0058, respectively). In this cohort, 33% had one of these factors, 36% had two, and 15% had all three.
This study highlights the high frequency of factors associated with poor tolerance to anticancer treatment in la/mUC patients. The findings suggest the need to establish optimal sequential treatment strategies, maximizing efficacy within time and tolerance constraints, while concurrently providing strong supportive care, considering immunological and nutritional aspects.
免疫检查点抑制剂和恩福妥单抗 vedotin 为局部晚期/转移性尿路上皮癌（la/mUC）的序贯治疗策略开辟了新途径。在恩福妥单抗 vedotin 之前，由于疾病快速进展和一般状况较差，许多患者无法接受三线治疗。本研究旨在分析日本 la/mUC 的真实世界序贯治疗实践，重点关注未接受三线治疗的患者。
我们分析了来自日本全国队列的 54 家机构在 2020 年 1 月至 2021 年 12 月期间诊断的 1023 例 la/mUC 患者的数据。
在中位随访 28.5 个月时，接受系统抗癌治疗的 905 例患者自一线治疗开始的中位总生存期为 19.1 个月。其中，81%和 32%接受了二线和三线治疗。值得注意的是，52%的患者在接受三线治疗之前停止了治疗。多变量逻辑回归分析显示，一线治疗开始时体能状态较差（≥1）、中性粒细胞与淋巴细胞比值升高（≥3）和低体重指数（<21kg/m）是未进行三线治疗的独立危险因素（p=0.0024、0.0069 和 0.0058）。在本队列中，33%的患者有一个上述因素，36%的患者有两个，15%的患者有三个。
本研究强调了 la/mUC 患者与抗癌治疗耐受性差相关的因素发生率较高。研究结果表明，需要制定最佳的序贯治疗策略，在时间和耐受性限制内最大限度地提高疗效，同时提供强有力的支持性护理，考虑免疫和营养方面。
