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Research ArticleClinical Studies

First-line Chemotherapy Response Is Associated With Clinical Outcome During Immune Checkpoint Inhibitor Treatment in Advanced Urothelial Carcinoma: A Real World Retrospective Study

JIAN-RI LI, SHIAN-SHIANG WANG, KEVIN LU, CHAUN-SHU CHEN, CHEN-LI CHENG, SHENG-CHUN HUNG, KUN-YUAN CHIU, CHIANN YI HSU and CHENG-KUANG YANG
Anticancer Research March 2023, 43 (3) 1331-1339; DOI: https://doi.org/10.21873/anticanres.16281
JIAN-RI LI
1Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.;
2Division of Surgical Intensive Care Unit, Department of Intensive Care, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.;
3Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, R.O.C.;
4Department of Medicine and Nursing, Hungkuang University, Taichung, Taiwan, R.O.C.;
5Institute of Biomedical Science, National Chung Hsing University, Taichung, Taiwan, R.O.C.;
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SHIAN-SHIANG WANG
1Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.;
3Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, R.O.C.;
6Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan, R.O.C.;
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KEVIN LU
1Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.;
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CHAUN-SHU CHEN
1Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.;
3Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, R.O.C.;
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CHEN-LI CHENG
1Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.;
3Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, R.O.C.;
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SHENG-CHUN HUNG
1Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.;
3Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, R.O.C.;
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KUN-YUAN CHIU
1Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.;
6Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan, R.O.C.;
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CHIANN YI HSU
7Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.
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CHENG-KUANG YANG
1Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.;
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  • For correspondence: gu5121@vghtc.gov.tw
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Abstract

Background/Aim: Immune checkpoint inhibitors (ICI) have become important tools for the treatment of advanced urothelial carcinoma (aUC). However, the clinical strategy using ICIs and chemotherapy is still controversial. The aim of this study was to evaluate the association of clinical parameters in aUC patients with ICI treatment. Patients and Methods: We retrospectively analyzed aUC patients who received atezolizumab and pembrolizumab between January 2015 and October 2020. The associations between baseline demographics and clinical outcomes were evaluated. Results: Of the 74 included patients, the median age was 67 years. Among them, 53 patients received atezolizumab and 21 received pembrolizumab. There were 50 patients receiving first line ICIs therapy and 24 receiving second line monotherapy. Fifty-two (83.87%, 52/62) received cisplatin among all chemotherapy patients. The median progression free survival was 10.94 months, and the overall survival was 28.44 months. Poor chemotherapy response or no chemotherapy, liver metastases, Eastern Cooperative Oncology Group (ECOG) status and higher neutrophil/lymphocyte ratio (NLR) were associated with higher risk of disease progression (HR=5.70, 95% CI=2.04-15.90, p=0.001; HR=6.08, 95% CI=1.79-20.57, p=0.004; HR=5.40, 95% CI=1.76-16.57, p=0.003; HR=6.08, 95% CI=2.56-14.44, p<0.001 and HR=1.02, 95% CI=1.01-1.03, p=0.002, respectively). Liver metastases and WBC before ICI were associated with increased risk of death (HR=11.95, 95% CI=3.22-44.34, p<0.001; HR=1.0001, 95%=CI=1.00001-1.00002, p=0.036 respectively) while ICI response was associated with decreased death (HR=0.22, 95%CI=0.08-0.62, p=0.004). Chemotherapy response was associated with better ICI treatment response (OR=6.52, 95% CI=1.45-29.24, p=0.014) while lymph node metastases and poor ECOG status were associated with poor ICI response (OR=0.31, 95% CI=0.10-0.94, p=0.038; OR=0.32, 95% CI=0.11-0.95, p=0.040). Conclusion: Our real-world data show a predictive role of first-line chemotherapy response to ICI treatment efficacy in aUC patients as well as other prognostic factors, such as ECOG status, serum WBC or NLR and liver metastases.

Key Words:
  • Immune check point inhibitors
  • urothelial carcinoma
  • cisplatin
  • pembrolizumab
  • atezolizumab
  • Received July 14, 2022.
  • Revision received September 3, 2022.
  • Accepted September 6, 2022.
  • Copyright © 2023 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.
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Anticancer Research: 43 (3)
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First-line Chemotherapy Response Is Associated With Clinical Outcome During Immune Checkpoint Inhibitor Treatment in Advanced Urothelial Carcinoma: A Real World Retrospective Study
JIAN-RI LI, SHIAN-SHIANG WANG, KEVIN LU, CHAUN-SHU CHEN, CHEN-LI CHENG, SHENG-CHUN HUNG, KUN-YUAN CHIU, CHIANN YI HSU, CHENG-KUANG YANG
Anticancer Research Mar 2023, 43 (3) 1331-1339; DOI: 10.21873/anticanres.16281

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First-line Chemotherapy Response Is Associated With Clinical Outcome During Immune Checkpoint Inhibitor Treatment in Advanced Urothelial Carcinoma: A Real World Retrospective Study
JIAN-RI LI, SHIAN-SHIANG WANG, KEVIN LU, CHAUN-SHU CHEN, CHEN-LI CHENG, SHENG-CHUN HUNG, KUN-YUAN CHIU, CHIANN YI HSU, CHENG-KUANG YANG
Anticancer Research Mar 2023, 43 (3) 1331-1339; DOI: 10.21873/anticanres.16281
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Keywords

  • Immune check point inhibitors
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