Abstract 781P
Background
In the current study, we evaluated pretreatment prognostic factors for overall survival (OS) in patients with metastatic urothelial carcinoma who have progressed after first-line chemotherapy in the Expanded-Access Program of atezolizumab.
Methods
In this study, we present the retrospective analysis of 113 patients with urothelial cancer treated with ATZ after progression on first-line chemotherapy. Eligible patients included metastatic urothelial carcinoma patients treated with at least one course of ATZ. Univariate analysis was used to identify clinical and laboratory factors that significantly impact OS. Variables were retained for multivariate analysis if they had a statistical relationship with OS (P˂0.1) and were then included the final model if P˂0.05.
Results
In univariate analysis, primary tumour location in the upper tract, increased absolute neutrophil count (ANC), increased absolute lymphocyte count, neutrophil-to-lymphocyte ratio (NLR)>3, liver metastases, baseline creatinine clearance (GFR) < 60 ml/min, Eastern Cooperative Oncology Group (ECOG) performance status (≥1) and hemoglobin<10 mg/dl were all significantly associated with OS. Three of the five adverse prognostic factors according to the Bellmunt criteria were independent of short survival: liver metastases (HR= 0.323; 95% CI 0.174-0.60; P <0.001), ECOG PS≥1 (HR= 0.459; 95% CI 0.236-0.895; p=0.022), and haemoglobin level <10 mg/dl (HR= 0.373; 95% CI 0.217-0.642; P <0.001). In addition, NLR>3 (HR= 0.474; 95% CI 0.234-0.962; P =0.039) and GFR <60 ml/min (HR= 0.546; 95% CI 0.328-0.907; P = 0.019), maintained a significant association with OS in multivariate analysis. Patients were divided into three risk categories: the favourable risk group (0-1 prognostic factor; median OS=20.1 mo.), the intermediate-risk group (2 prognostic factors; median OS=10.08 mo.) and the poor-risk group (3≥ prognostic risk groups; median OS= 2.2 mo.) (log-rank P< 0.001).
Conclusions
This model confirms the Bellmunt model with the addition of NLR>3 and GFR <60 ml/min. Taken together, these factors can be used for prognostic parameters in clinical trials that use immunotherapy in patients with bladder cancer who have progressed after first-line chemotherapy.
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.