Outcome of metastatic urothelial carcinoma treated by systemic chemotherapy: Prognostic factors based on real-world clinical practice in Japan

Background: We evaluated the prognostic efficacy of the Geriatric Nutritional Risk Index (GNRI) in second-line pembrolizumab (PEM) therapy for patients with metastatic urothelial carcinoma (mUC). Patients and Methods: From January 2018 to October 2019, 52 mUC patients, treated previously with platinum-based chemotherapy, underwent second-line PEM therapy. Peripheral blood parameters were measured at the start of treatment: serum neutrophil-to-lymphocyte ratio (NLR), serum albumin, serum C-reactive protein (CRP), and body height and weight. PEM was intravenously administered (200 mg every 3 weeks). The patients were organized into two groups based on their GNRI (<92 [low GNRI] and ≥92 [high GNRI]), and the data were retrospectively analyzed. Adverse events (AEs) were evaluated and imaging studies assessed for all patients. Analyses of survival and recurrence were performed using Kaplan-Meier curves. Potential prognostic factors affecting cancer-specific survival (CSS) were assessed by univariate and multivariate Cox regression analyses. Results: patients’ baseline characteristics, except for their BMI and objective response rate, did not significantly differ between the two groups. The median total number of cycles of PEM therapy was significantly higher for the high-GNRI group (n [range]: 6 [2–20] vs. 3 [1–6]). The median CSS with second-line PEM therapy was 3.6 months (95% confidence interval [CI]: 2.5–6.1) and 11.8 months (95% CI: 6.2–NA) in the low-GNRI and the high-GNRI group (p < 0.01), respectively. Significant differences in CSS between the low- and high-CRP or -NRL groups were not found. Multivariate Cox proportional-hazards regression analysis revealed that a poor Eastern Cooperative Oncology Group performance status, visceral metastasis, and a low GNRI were significant prognostic factors for short CSS (95% CI: 1.62–6.10, HR: 3.14; 95% CI: 1.13–8.11, HR: 3.03; 95% CI: 1.32–8.02, HR: 3.25, respectively). Of the AEs, fatigue showed a significantly higher incidence in the low-GNRI group. Conclusions: For mUC patients receiving second-line PEM therapy, the GNRI is a useful predictive biomarker for survival outcome.

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First-line immune checkpoint inhibitors for patients with metastatic urothelial carcinoma treated in routine clinical practice

Translational Andrology and Urology ◽

10.21037/tau.2020.04.08 ◽

2020 ◽

Vol 9 (3) ◽

pp. 986-990

Author(s):

Renato Naito ◽

Kouji Izumi ◽

Atsushi Mizokami

Keyword(s):

Clinical Practice ◽

Urothelial Carcinoma ◽

Immune Checkpoint ◽

Immune Checkpoint Inhibitors ◽

Checkpoint Inhibitors ◽

Routine Clinical Practice ◽

First Line ◽

Metastatic Urothelial Carcinoma

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Bladder cancer. A retrospective analysis of the use of vinfluvin in real clinical practice

Research n Practical Medicine Journal ◽

10.17709/2410-1893-2021-8-2-3 ◽

2021 ◽

Vol 8 (2) ◽

pp. 34-42

Author(s):

A. S. Zhabina ◽

A. I. Novikov ◽

F. V. Moiseenko ◽

N. M. Volkov ◽

E. O. Stepanova ◽

...

Keyword(s):

Clinical Trial ◽

Clinical Practice ◽

Adverse Events ◽

Medical Care ◽

Urothelial Carcinoma ◽

Response Duration ◽

Complete Response ◽

Metastatic Urothelial Carcinoma ◽

Real Practice ◽

Real Clinical Practice

Purpose of the study. There is the generalized analysis of administration of vinflunine in real clinical practice in St.Petersburg Clinical Scientific and Practical Center of Specialized medical Care (oncological).Materials and methods. This analysis gathered 27 patients with urothelial carcinoma treated using this medicine in St.Petersburg Clinical Scientific and Practical Center of Specialized medical Care (oncological). We assessed efficacy, safety profile of vinflunine in this subset of patients.Results. Clinical efficacy of vinflunine (complete response + partial response + stable disease) was 51,86 %, one patient demonstrated complete response. Median of response duration accounts for 3,4 months. Adverse events were observed in 28,4 %, most of them were 1-2 grades. 2 patients stopped therapy due to adverse events.Conclusion. In our analysis vinflunine was more effective than in randomized clinical trial and other studies from real practice in Europe. Thus, confirm expediency to administer of vinflunine for metastatic urothelial carcinoma.

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701P Real-world (RW) treatment (Tx) patterns and clinical outcomes in patients (pts) with metastatic urothelial carcinoma (mUC) receiving first-line (1L) Tx: Results from IMPACT UC

Annals of Oncology ◽

10.1016/j.annonc.2021.08.097 ◽

2021 ◽

Vol 32 ◽

pp. S713

Author(s):

M.A. Bilen ◽

A.D. Xi ◽

A. Wong ◽

A. Schroeder ◽

R. Kim ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Clinical Outcomes ◽

Real World ◽

First Line ◽

Metastatic Urothelial Carcinoma

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Prognostic impact of local radiotherapy on metastatic urothelial carcinoma patients receiving systemic chemotherapy

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyz152 ◽

2019 ◽

Author(s):

Takashige Abe ◽

Keita Minami ◽

Toru Harabayashi ◽

Ataru Sazawa ◽

Hiroki Chiba ◽

...

Keyword(s):

Overall Survival ◽

Disease Control ◽

Urothelial Carcinoma ◽

Systemic Chemotherapy ◽

Hazard Ratio ◽

Prognostic Impact ◽

Significant Difference ◽

Metastatic Urothelial Carcinoma ◽

Consolidative Radiotherapy

Abstract Objective To clarify the prognostic impact of local radiotherapy on metastatic urothelial carcinoma patients treated by systemic chemotherapy. Methods Of the 228 metastatic urothelial carcinoma patients treated with systemic chemotherapy, 97 received radiotherapy mainly to metastatic sites. In patients for whom the purpose of radiotherapy was not specified, more than 50 Gy irradiation was considered to be for disease consolidation for survival analysis, while less than 50 Gy was categorized as palliation. According to the Kaplan–Meier method, we analysed overall survival from the initiation of treatment for metastatic urothelial carcinoma until death or the last follow-up, using the log-rank test to assess the significance of differences. The Cox model was applied for prognostic factor analysis. Results Overall, there was no significant difference in survival between patients with and those without radiotherapy (P = 0.1532). When analysing the patients undergoing consolidative radiotherapy separately, these 25 patients showed significantly longer survival than the 72 patients with palliative radiotherapy (P = 0.0047), with a 3-year overall survival of 43.3%. Of the present cohort, 22 underwent metastasectomy for disease consolidation, and there was no overlapping case between the metastasectomy cohort and cohort receiving consolidative radiotherapy. After controlling for four independent prognostic factors (sex, performance status, haemoglobin level and number of organs with metastasis) in our previous study, radiotherapy for disease consolidation showed a marginal value (hazard ratio = 0.666, P = 0.0966), while metastasectomy remained significant (hazard ratio = 0.358, P = 0.0006). Conclusions In the selected patients, long-term disease control could be achieved after consolidative radiotherapy for metastatic urothelial carcinoma disease. Our observations suggest that local ablative therapy (surgery or radiotherapy) could facilitate long-term disease control. However, the treatment decision should be individualized because of the lack of randomized control trials.

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