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Poster session 24

2384P - Platinum rechallenge in the era of immune checkpoint inhibitor in locally advanced/metastatic urothelial carcinoma: Multicenter retrospective study

Date

21 Oct 2023

Session

Poster session 24

Topics

Cytotoxic Therapy

Tumour Site

Urothelial Cancer

Presenters

Eojin Kim

Citation

Annals of Oncology (2023) 34 (suppl_2): S1202-S1228. 10.1016/S0923-7534(23)01271-1

Authors

E. Kim1, J.H. Kim2, J. Chu3, Y. Lee1, H. Im4

Author affiliations

  • 1 Department Of Hematology And Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 03181 - Seoul/KR
  • 2 Department Of Oncology-hematology, Korea University Anam Hospital, 02841 - Seoul/KR
  • 3 Department Of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 03181 - Seoul/KR
  • 4 Department Of Hematology And Oncology, Ulsan University Hospital, 06973 - Ulsan/KR

Resources

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Abstract 2384P

Background

In locally advanced/metastatic urothelial carcinoma (UC) which progressed after platinum-based chemotherapy (P), treatment with 2nd-line immune checkpoint inhibitor (ICI) is considered. If disease progresses thereafter, there is no domestically approved drug with proven OS benefit in Korea, despite the development of new drugs. Therefore, P rechallenge is common in clinical practice, in spite of little evidence. This study aimed to evaluate efficacy of P rechallenge, and to explore clinical/genetic biomarkers predicting the efficacy of P rechallenge in locally advanced/metastatic UC.

Methods

A total of 66 patients who rechallenged P for locally advanced/metastatic UC from Jan 2017 to Mar 2023 in 3 tertiary referral hospitals was included. Clinical data were retrospectively evaluated. Next generation sequencing was performed for 43 available patients.

Results

Gemcitabine-based regimens (GP, GCb; [G]; n=28), MVAC-based regimens (MVAC/Cb, ddMVAC; [M]; n=35) and other P (n=3) were administered for P rechallenge; ORR, median PFS and OS were 40.9%, 4.5 and 8.7 months. In patients who received [G] for both 1st-line-P and P-rechallenge (n=24), whose ORR (70.8%) and median TTP (7 months) were favorable to 1st-line P, ORR of P rechallenge was 66.7%. On the other hand, in patients who received 1st-line [G] and rechallenged P with [M] (n=35), whose ORR (45.7%) and mTTP (0.5 months) were relatively poor with 1st-line P, ORR of P rechallenge was 22.9%. Median OS of P rechallenge were significantly longer in patients who received ICI between 1st-line-P and P-rechallenge than those who did not receive (12.4 vs 6.5 months, p=.004). In multivariate analysis, poor response to 1st-line P, visceral metastasis and no alterations in DNA damage repair (DDR) genes were significant prognostic factors for poorer OS after P rechallenge.

Conclusions

This study demonstrated favorable efficacy of P rechallenge in era of ICI in locally advanced/metastatic UC, providing a basis for treatment decision after P and ICI failure. P rechallenge showed fair efficacy even in poorly responded patients from 1st-line P. DDR gene alterations and ICI use before P rechallenge may be associated with improved survival after P rechallenge.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Korean Society of Medical Oncology (KSMO).

Disclosure

All authors have declared no conflicts of interest.

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