Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
Division of Fostering Required Medical Human Resources, Center for Infectious Disease Education and Research (CiDER), Osaka University, Osaka, 565-0871, Japan.
Sci Rep. 2024 Oct 4;14(1):23128. doi: 10.1038/s41598-024-72755-8.
Real-world data on health-related quality of life (HRQoL) in advanced urothelial carcinoma (aUC) receiving immune checkpoint inhibitors (ICIs) are limited. This study included 42 patients with aUC who received second-line or later pembrolizumab (n = 19), maintenance avelumab followed by first-line chemotherapy (n = 13), or adjuvant nivolumab after radical surgery (n = 10). Time-course changes in the domains and scales related to HRQoL were evaluated using the EORTC QLQ-C30, FACT-G, and SF-8 questionnaires during ICI therapy. Anchor-based approaches for minimally important differences were determined as 'improved', 'stable', and 'deteriorated'. We found significant improvements after the start of pembrolizumab treatment on many scales. Almost none of the scales changed significantly in the avelumab and nivolumab groups. Approximately 80% of the pembrolizumab group had deteriorated social/family well-being in FACT-G. Approximately 60% of the patients in the avelumab group had deteriorated general health and vitality in SF-8. In the nivolumab group, none of the scales deteriorated in > 50% of the patients. Deterioration of physical function in the SF-8 was associated with occurrence of treatment-related adverse events ≥ grade 2 during ICI therapy (P = 0.013). Our findings demonstrated that majority of patients with aUC who received ICI therapy had a stable HRQoL, which was consistent with evidence from clinical trials.
在接受免疫检查点抑制剂(ICI)治疗的晚期尿路上皮癌(aUC)患者中,有关健康相关生活质量(HRQoL)的真实世界数据有限。本研究纳入了 42 例接受二线或后线帕博利珠单抗(n=19)、维持avelumab 后序贯一线化疗(n=13)或根治性手术后辅助nivolumab(n=10)治疗的 aUC 患者。在 ICI 治疗期间,使用 EORTC QLQ-C30、FACT-G 和 SF-8 问卷评估与 HRQoL 相关的各领域和量表的时间变化。采用基于锚定的方法确定最小临床重要差异为“改善”、“稳定”和“恶化”。我们发现,在开始接受帕博利珠单抗治疗后,许多量表的评分均显著改善。avelumab 和 nivolumab 组的大多数量表均无显著变化。在帕博利珠单抗组中,约 80%的患者在 FACT-G 中社会/家庭幸福感恶化。在 avelumab 组中,约 60%的患者在 SF-8 中一般健康和活力恶化。在 nivolumab 组中,无任何量表在>50%的患者中恶化。SF-8 中的身体功能恶化与 ICI 治疗期间发生≥2 级治疗相关不良事件(P=0.013)相关。我们的研究结果表明,接受 ICI 治疗的大多数 aUC 患者 HRQoL 稳定,这与临床试验证据一致。