Association of response to first-line chemotherapy with the efficacy of atezolizumab in patients with metastatic urothelial carcinoma
Erişim
info:eu-repo/semantics/closedAccessTarih
2021Yazar
Tural, DenizÖlmez, Ömer Fatih
Sümbül, Ahmet Taner
Artaç, Mehmet
Özhan, Nail
Akar, Emre
Çakar, Burcu
Köstek, Osman
Ekenel, Meltem
Coşkun, Hasan Şenol
Selçukbiricik, Fatih
Keskin, Özge
Paksoy Türköz, Fatma
Oruç, Kerem
Bayram, Selami
Yılmaz, Uğur
Bilgetekin, İrem
Yıldız, Birol
Şendur, Mehmet Ali Nahit
Erman, Mustafa
Üst veri
Tüm öğe kaydını gösterKünye
Tural, D., Ölmez, Ö. F., Sümbül, A. T., Artaç, M., Özhan, N., Akar, E. ... Erman, M. (2021). Association of response to first-line chemotherapy with the efficacy of atezolizumab in patients with metastatic urothelial carcinoma. Journal of Clinical Oncology. https://dx.doi.org/10.1200/JCO.2021.39.6_suppl.409Özet
Background: In the current study, we evaluated whether the response first-line chemotherapy could impact atezolizumab benefit in terms of response rate and overall survival in patients with metastatic urothelial carcinoma. Methods: In this study, we present the retrospective analysis of 105 patients with urothelial cancer treated with ATZ after progression on first-line chemotherapy. The association between response to first-line chemotherapy and ATZ was assessed using Fisher’s exact test. Overall survival (OS) was estimated by using the Kaplan-Meier method. 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 then included the final model if p˂0.05. Results: Best response to first-line chemotherapy was complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) in 5(4.8%), 38(36.2%), 16(15.2%), 46(43.8%) patients, respectively. Best response to atezolizumab was CR, PR, SD, PD in 9(8.6%), 22(21%), 23(21,9%), 51(48,5%). Forty (74.1%) of patients who benefited from first-line chemotherapy also benefited from atezolizumab, while only 14 (25.9%) of patients with initial PD after first-line chemotherapy subsequently experienced clinical benefit with atezolizumab (Fisher’s exact test, p=0.001). Patients with clinical benefit from first-line chemotherapy had a higher OS. The median OS of atezolizumab were 14.8 and 3.4 months for patients with clinical benefit and progressive disease in response to first-line chemotherapy, respectively (log-rank p=0.001). In univariate analysis, Patients with clinical benefit from first-line chemotherapy, liver metastases, baseline creatinine clearance less (GFR)than 60 ml/min, Eastern Cooperative Oncology Group (ECOG) performance status (1 ≥), and hemoglobin levels below 10 mg/dl were all significantly associated with OS. Three of the adverse prognostic factors according to the Bellmunt criteria were independent factor of short survival: liver metastases (Hazard Ratio [HR]= 0.6; 95% CI 0.174-0.60; p=0.04), ECOG PS≥1 (HR= 0.36; 95% CI 0.2-0.66; p=0.001), and Hemoglobin level below 10 mg/dl (HR= 0.36; 95% CI 0.2-0.66; p <0.001). In addition, Patients with clinical benefit from first-line chemotherapy (HR= 0.39; 95% CI 0.24-0.65; p <0.001) maintained a significant association with OS in multivariate analysis. Conclusions: Our study demonstrated that clinical benefit from first-line chemotherapy was independent prognostic factor on OS in patients' use of atezolizumab as second-line treatment in metastatic bladder cancer. Furthermore, these findings are important for stratification factors for future immunotherapy study design in patients with bladder cancer who have progressed after first-line chemotherapy.
WoS Q Kategorisi
Q1Kaynak
Journal of Clinical OncologyCilt
39Sayı
6Bağlantı
https://dx.doi.org/10.1200/JCO.2021.39.6_suppl.409https://hdl.handle.net/20.500.12511/6766
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