Kobatake Kohei, Goto Keisuke, Sakamoto Yuki, Iwane Kyohsuke, Nishida Kensuke, Hashimoto Kunihiro, Asami Akihiro, Iwamoto Hideo, Hayashi Tetsutaro, Takemoto Kenshiro, Naito Miki, Miyamoto Shunsuke, Sekino Yohei, Kitano Hiroyuki, Goriki Akihiro, Hieda Keisuke, Hinata Nobuyuki
Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Urology, Hiroshima-Nishi Medical Center, Otake City, Hiroshima, Japan.
Int J Urol. 2025 May;32(5):524-530. doi: 10.1111/iju.15686. Epub 2025 Feb 10.
This study evaluated whether first-line treatment affects survival outcomes in patients with advanced urothelial carcinoma undergoing sequential therapy with chemotherapy, immune checkpoint inhibitors, and enfortumab vedotin.
This multicenter retrospective study included 57 patients treated at Hiroshima University Hospital and its affiliated institutions between 2009 and 2024. Patients received chemotherapy as a first-line treatment (gemcitabine plus cisplatin or carboplatin), followed by second-line immune checkpoint inhibitors (pembrolizumab or avelumab) and third-line enfortumab vedotin. Assessed outcomes included overall survival and time to treatment failure. Cox regression analysis identified prognostic factors for overall survival.
Over a median follow-up of 20.5 months, median overall survival was not reached after first-line treatment. Gemcitabine with cisplatin was selected in 31.6% of cases, while gemcitabine and carboplatin was chosen in 68.4% of cases as the first-line treatment; subsequently, 66.7% received pembrolizumab, and 33.3% received avelumab in the second-line treatment. Patients who achieved a complete or partial response with the first-line treatment had significantly longer overall survivals from both first-line and enfortumab vedotin initiation than those with stable or progressive disease. In cases that achieved complete or partial responses, avelumab was more frequently selected as a second-line therapy. However, in the first-line treatment, multivariate analysis identified only stable or progressive disease as a significant predictor of worse overall survival.
The best response to first-line treatment predicted both overall survival from first-line initiation and outcomes following enfortumab vedotin treatment, underscoring its prognostic value in sequential therapy for patients with advanced urothelial carcinoma.
本研究评估一线治疗对接受化疗、免疫检查点抑制剂和恩杂鲁胺序贯治疗的晚期尿路上皮癌患者生存结局的影响。
这项多中心回顾性研究纳入了2009年至2024年间在广岛大学医院及其附属机构接受治疗的57例患者。患者接受化疗作为一线治疗（吉西他滨联合顺铂或卡铂），随后接受二线免疫检查点抑制剂（帕博利珠单抗或阿维鲁单抗）和三线恩杂鲁胺治疗。评估的结局包括总生存期和治疗失败时间。Cox回归分析确定了总生存期的预后因素。
在中位随访20.5个月期间，一线治疗后未达到中位总生存期。31.6%的病例选择吉西他滨联合顺铂作为一线治疗，68.4%的病例选择吉西他滨联合卡铂作为一线治疗；随后，66.7%的患者在二线治疗中接受帕博利珠单抗，33.3%的患者接受阿维鲁单抗。一线治疗达到完全或部分缓解的患者从一线治疗和恩杂鲁胺开始治疗后的总生存期明显长于疾病稳定或进展的患者。在达到完全或部分缓解的病例中，阿维鲁单抗更常被选为二线治疗。然而，在一线治疗中，多变量分析仅确定疾病稳定或进展是总生存期较差的显著预测因素。
一线治疗的最佳反应预测了从一线治疗开始的总生存期以及恩杂鲁胺治疗后的结局，强调了其在晚期尿路上皮癌患者序贯治疗中的预后价值。
