Immune check point inhibitors for metastatic urothelial carcinoma: current evidence-based approach for urology daily practice

Check-point inhibitors have erupted as a treatment option for numerous kinds of neoplasms. Although there have been some achievements, the evidence supporting their use in breast cancer is scarce. Combinations with chemotherapy seem to provide better outcomes, and triple negative is the subtype most likely to benefit from them. New combination strategies are undergoing research to improve these results. Other approaches to determining biomarkers that identify which populations clearly benefit from these therapies are needed. Here, we review the clinical data of the role of immune check-point inhibitors in early and advanced breast cancer and present emerging strategies.

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Immunotherapy of brain metastases: breaking a “dogma”

Journal of Experimental & Clinical Cancer Research ◽

10.1186/s13046-019-1426-2 ◽

2019 ◽

Vol 38 (1) ◽

Cited By ~ 10

Author(s):

Anna Maria Di Giacomo ◽

Monica Valente ◽

Alfonso Cerase ◽

Maria Fortunata Lofiego ◽

Francesca Piazzini ◽

...

Keyword(s):

Clinical Trials ◽

Brain Metastases ◽

Case Series ◽

Daily Practice ◽

Clinical Activity ◽

Check Point ◽

Wide Range ◽

Check Point Inhibitors ◽

Clinical Responses ◽

The Central Nervous System

Abstract Until very few years ago, the oncology community dogmatically excluded any clinical potential for immunotherapy in controlling brain metastases. Therefore, despite the significant therapeutic efficacy of monoclonal antibodies to immune check-point(s) across a wide range of tumor types, patients with brain disease were invariably excluded from clinical trials with these agents. Recent insights on the immune landscape of the central nervous system, as well as of the brain tumor microenvironment, are shedding light on the immune-biology of brain metastases. Interestingly, retrospective analyses, case series, and initial prospective clinical trials have recently investigated the role of different immune check-point inhibitors in brain metastases, reporting a significant clinical activity also in this subset of patients. These findings, and their swift translation in the daily practice, are driving fundamental changes in the clinical management of patients with brain metastases, and raise important neuroradiologic challenges. Along this line, neuro-oncology undoubtedly represents an additional area of active investigation and of growing interest to support medical oncologists in the evaluation of clinical responses of brain metastases to ICI treatment, and in the management of neurologic immune-related adverse events. Aim of this review is to summarize the most recent findings on brain metastases immunobiology, on the evolving scenario of clinical efficacy of ICI therapy in patients with brain metastases, as well as on the increasing relevance of neuroradiology in this therapeutic setting.

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Continuing to Challenge Practice to Be Evidence Based

Critical Care Nurse ◽

10.4037/ccn2015693 ◽

2015 ◽

Vol 35 (2) ◽

pp. 39-50 ◽

Cited By ~ 7

Author(s):

Mary Beth Flynn Makic ◽

Carol Rauen ◽

Kimmith Jones ◽

Anna C. Fisk

Keyword(s):

Critical Care ◽

Daily Practice ◽

Medication Administration ◽

Chest Physiotherapy ◽

Critical Care Nurses ◽

Current Evidence ◽

Care Practice ◽

Evidence Based ◽

Actual Weight ◽

Daily Interruption

Practice habits continue in clinical practice despite the availability of research and other forms of evidence that should be used to guide critical care practice interventions. This article is based on a presentation at the 2014 National Teaching Institute of the American Association of Critical-Care Nurses. The article is part of a series of articles that challenge critical care nurses to examine the evidence guiding nursing practice interventions. Four common practice interventions are reviewed: (1) weight-based medication administration, (2) chest tube patency maintenance, (3) daily interruption of sedation, and (4) use of chest physiotherapy in children. For weight-based administration of medication, the patient’s actual weight should be measured, rather than using an estimate. The therapeutic effectiveness and dosages of medications used in obese patients must be critically evaluated. Maintaining patency of chest tubes does not require stripping and milking, which probably do more harm than good. Daily interruption of sedation and judicious use of sedatives are appropriate in most patients receiving mechanical ventilation. Traditional chest physiotherapy does not help children with pneumonia, bronchiolitis, or asthma and does not prevent atelectasis after extubation. Critical care nurses are challenged to evaluate their individual practice and to adopt current evidence-based practice interventions into their daily practice.

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Examining the Evidence to Guide Practice: Challenging Practice Habits

Critical Care Nurse ◽

10.4037/ccn2014262 ◽

2014 ◽

Vol 34 (2) ◽

pp. 28-45 ◽

Cited By ~ 12

Author(s):

Mary Beth Flynn Makic ◽

Carol Rauen ◽

Robin Watson ◽

Ann Will Poteet

Keyword(s):

Critical Care ◽

Current Practice ◽

American Association ◽

Daily Practice ◽

Feeding Tube ◽

Critical Care Nurses ◽

Current Evidence ◽

Evidence Based ◽

Health Care Workforce ◽

In Infants And Children

Nurses are the largest segment of the nation’s health care workforce, which makes nurses vital to the translation of evidence-based practice as a practice norm. Critical care nurses are in a position to critically appraise and apply best evidence in daily practice to improve patients’ outcomes. It is important for critical care nurses to continually evaluate their current practice to ensure that they are applying the current best evidence rather than practicing on the basis of tradition. This article is based on a presentation at the 2013 National Teaching Institute of the American Association of Critical-Care Nurses. Four practice interventions that are within the realm of nursing are critiqued on the basis of current best evidence: (1) turning critically ill patients, (2) sleep promotion in the intensive care unit, (3) feeding tube management in infants and children, and (4) prevention of venothromboembolism…again. The related beliefs, current evidence, and implications for practice associated with each topic are described.

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Outcomes of advanced urothelial carcinoma following discontinuation of programmed death (PD)-1 or PD-ligand (L)-1 inhibitors.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.2_suppl.385 ◽

2016 ◽

Vol 34 (2_suppl) ◽

pp. 385-385 ◽

Cited By ~ 1

Author(s):

Guru Sonpavde ◽

Gregory Russell Pond ◽

Stephanie A. Mullane ◽

Ana Arlene Ramirez ◽

Nicholas J. Vogelzang ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Median Time ◽

Systemic Therapy ◽

Salvage Therapy ◽

Cox Regression ◽

Performance Status ◽

Inhibitor Therapy ◽

Check Point ◽

Check Point Inhibitors ◽

Advanced Urothelial Carcinoma

385 Background: The outcomes and therapy of advanced urothelial carcinoma (UC) patients (pts) following discontinuation of PD-1/PD-L1 inhibitors are unclear. We performed a retrospective analysis to examine the frequency of systemic therapy administered following PD-1/PD-L-1 inhibitors and outcomes in these pts. Methods: Data were collected from institutions for pts with advanced UC following prior PD-1/PD-L1 inhibitors as salvage therapy. Baseline demographics and therapy administered following prior check-point inhibitors was captured. Univariable Cox regression analyses examined clinical factors potentially associated with overall survival (OS) following check-point inhibitors. Results: Data from 62 pts were available from 4 institutions with capture of therapy and outcomes following checkpoint inhibitor immunotherapy. The median age was 65.5 years and 51 (82.3%) were male. The median duration of PD-1/PD-L1 inhibitors available from 55 pts was 64 days (range 7-669). Of these pts, 22 (35.5%) received post-PD1/PD-L1 pathway inhibitor therapy with a variety of chemotherapy (n = 16), chemobiologic combination (n = 1), biologic agents (n = 4) and immunotherapy (n = 1). The median time from last PD1/PD-L1 pathway inhibitor therapy to subsequent therapy was 58 days (range 14-242). The median OS of all pts following completion of PD-1/PD-L1 inhibitors was 149 days (95% CI: 75-359). Among pts who received some post-PD1/PD-L1 pathway inhibitor therapy, median OS was 182 days (95% CI: 121-372), and the median time to progression was 124 days (95% CI: 61-273) when examining from start of post-PD1/PD-L1 therapy. Among these 22 pts, the only significant baseline prognostic factor associated with OS was performance status. Conclusions: In this dataset, 35.5% of pts with advanced UC received subsequent systemic therapy following salvage therapy with PD1/PD-L1 inhibitors. Outcomes with subsequent therapy appear similar to historically observed outcomes in pts who had not received prior PD1/PD-L1 inhibitors. Further study of pts post-PD1/PD-L1 inhibitor therapy is warranted to identify factors associated with outcomes and potentially synergistic sequences.

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Immune Checkpoint Inhibitor (ICPI) induced Nephrotoxicity – An Insight.

JMS SKIMS ◽

10.33883/jms.v23i3.774 ◽

2020 ◽

Vol 23 (3) ◽

Author(s):

Mohmad Hussian Mir ◽

Tariq Ahmad Bhat ◽

Khalid Parvez Sofi ◽

Imtiyaz Ahmad Wani ◽

Muzafar Maqsood Wani

Keyword(s):

Acute Kidney Injury ◽

Immune Checkpoint Inhibitor ◽

Checkpoint Inhibitor ◽

Kidney Injury ◽

Check Point ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

New Class ◽

Transplant Patients ◽

Check Point Inhibitors

Immune check point inhibitors (ICPIs) are a new class of anti-neoplastic agents being increasingly used by oncologists to treat various malignancies. These drugs have been associated with varied side effects and have a nephrotoxic potential. Many cases of ICPI induced acute kidney injury are increasingly being reported. Their use in CKD patients on dialysis as well as in kidney transplant recipients is associated with various challenges. This review discusses the use of ICPIs in CKD, dialysis and renal transplant patients and their nephrotoxic potential

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