Abstract 765P
Background
Metastatic urothelial cancer patients can be treated with immune checkpoint inhibitors (ICIs) in the first- and second-line settings. Real world data is limited. Although there is a survival benefit with second-line ICIs, only 1 in 5 patients experience a durable response. We conducted a multicentre analysis exploring prognostic clinical parameters and their impact on progression-free (PFS) and overall survival (OS).
Methods
Between March 2017 and February 2020, data for 208 metastatic urothelial patients treated with single-agent pembrolizumab or atezolizumab were collected retrospectively from 5 centres. PFS was defined as the time from the first date of immunotherapy to disease progression or death from any cause. Clinical parameters such as age, gender, performance status, smoking history, presence of visceral or liver metastasis, haemoglobin level(Hb), lymphocyte count, neutrophil count, lactate dehydrogenase levels (LDH) and PDL-1 status were collected. Kaplan–Meier and Cox hazard methods were used for survival analysis.
Results
Out of 208 patients, 26(12.5%) received first-line ICIs. Median PFS and OS were 4.5 (range 3.5- 5.7) and 9.2 (range 7.4-10.5) months, respectively. On univariable analysis for OS, liver metastasis, neutrophil count, neutrophil lymphocyte ratio, haemoglobin, and LDH levels were independent prognostic factors. Table: 765P
| Multivariable analyses for OS using Cox progression hazard model | ||
| Variable | Hazard ratio | P-value |
| Liver metastasis (Yes or No) | 3.03(1.92-4.71) | <0.001 |
| Haemoglobin | 0.91(0.81-1.00) | 0.05 |
| Neutrophil count | 2.58(1.19-5.55) | 0.01 |
| Lymphocyte count | 0.33(0.13-0.76) | 0.01 |
Conclusions
In this large real world data set, we have demonstrated a strong association between OS and known prognostic factors such as liver metastases and Hb level, but interestingly novel factors, neutrophil, and lymphocyte count also. These parameters could be used to create a stratification model, which, if independently validated, could help in selecting patients with urothelial cancer who benefit from ICIs.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The Christie NHS trust.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.