237P - Real-world analysis of adjuvant nivolumab in resected urothelial cancer: A single institute study in Taiwanese patients

Background

Advanced urothelial cancer is an aggressive tumor type with high propensity of recurrence even after adequate surgical resection. The CheckMate-274 trial heralded a new era for resected urothelial cancer by the addition of adjuvant nivolumab which significantly reduced recurrence rate and prolonged survival. In the CheckMate-274 trial, 21% of the patients were upper urinary tract cancers (UTUC, including renal pelvis, collecting duct, ureter), reflecting the prevalence of UTUC in the western population. Asian patients have a significantly higher proportion of UTUC compared to western countries. Furthermore, in Asia, especially Taiwan, the etiology of urothelial cancers is likely distinct from western countries, with environmental factors as a main contributing factor. Therefore, the clinical efficacy of nivolumab in resected UTUC is relatively underinvestigated and warrants more research.

Methods

We retrospectively analyzed patients with resected urothelial cancer at the Taipei Veterans General Hospital, Taiwan, who received adjuvant nivolumab following adequate surgical resection. Clinical and pathological information were gathered and analyzed. We further collected genomic and clinical data for a further analysis of patients who had recurrence after completing adjuvant nivolumab.

Results

Our cohort included a total of 22 patients. 14 were female, 8 were male patients. 2 patients had bladder cancer, 4 patients had cancer of the ureter, and 16 patients had cancer of the renal pelvis (total of 20 UTUC). 3 patients were stage 2, 11 patients were stage 3, 8 patients were stage 4. With a median follow up time of 422.5 days, 7 patients had recurrence. In all 7 patients with recurrence, the median time to recurrence was 224 days (7.47 months). In the overall cohort, DFS was still not reached since the majority of patients were still in remission. We further performed genetic and pathological analysis for patients with recurrence.

Conclusions

Urothelial cancer is an aggressive disease with a dismal outcome. Adjuvant nivolumab significantly improved outcomes, but a portion of patients still present with rapid recurrence. Our study highlights the aggressiveness of UTUC which is highly prevalent in Asian countries.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.