Abstract 309P
Background
In Japan, pembrolizumab became available for platinum-resistant urothelial carcinoma in 2017, followed by avelumab maintenance therapy. With potent first-line therapies, case-by-case treatment selection is anticipated. This study aims to assess risk stratification of advanced urothelial carcinoma in the era of cancer immunotherapy.
Methods
137 patients (58 with bladder cancer) who initiated first-line chemotherapy between December 2017 and December 2023 were enrolled. Cox proportional hazards models were used to investigate predictors of overall survival (OS). Risk was stratified into three groups based on the number of factors.
Results
The median age was 74 years, with males accounting for 95 cases. Of the 131 patients who discontinued first-line therapy, 100 (76.3%) switched to an immuno-oncology (IO) drug: avelumab in 23 and pembrolizumab in 77 patients. Of the 81 patients who discontinued IO drugs, 40 (49.4%) switched to subsequent therapy. Predictors of OS included ECOG-PS ≥ 2, histological variant, CRP level, and liver metastases. The median OS in the favorable (Factor 0, 53 patients), intermediate (Factor 1, 46 patients), and poor (Factor ≥2, 38 patients) risk groups were 43.9, 16.4, and 8.3 months, respectively. Twenty-six patients (68.4%) in the poor risk had PS ≥ 2 at treatment start, with a conversion rate to IO drugs of 63.2%, lower than in the other groups. Disease control after four courses of first-line therapy was achieved in 26 (49.1%) and 27 (32.1%) patients in the favorable and intermediate + poor risk, respectively. The median progression-free survival in 14 patients in the favorable risk who switched to avelumab maintenance was 9.3 months, significantly longer than 3.7 months in the intermediate + poor risk (9 patients). The median OS after switching to avelumab maintenance was 18.1 months in the intermediate + poor risk, but not reached in the favorable risk.
Conclusions
The OS of the cohort in the era of cancer immunotherapy until 2023 has not improved compared to previous years. The prognosis in the poor risk remains unfavorable. While novel therapies may offer promise, many patients have decreased PS, and therapy choice should be carefully considered. Some favorable risk cases show a good prognosis even with conventional therapy.
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.