Journal article
Response and Outcomes to Immune Checkpoint Inhibitors in Advanced Urothelial Cancer Based on Prior Intravesical Bacillus Calmette-Guerin
Clinical genitourinary cancer, Vol.20(2), pp.165-175
04/01/2022
DOI: 10.1016/j.clgc.2021.12.012
PMCID: PMC8995351
PMID: 35078711
Abstract
Immune checkpoint inhibitors (ICI) improve overall survival (OS) in patients with locally advanced, unresectable, or metastatic urothelial carcinoma (aUC), but response rates can be modest. We compared outcomes between patients with and without prior intravesical Bacillus Calmette-Guerin (BCG), who received ICI for aUC, hypothesizing that prior intravesical BCG would be associated with worse outcomes.
We performed a retrospective cohort study across 25 institutions in US and Europe. We compared observed response rate (ORR) using logistic regression; progression-free survival (PFS) and OS using Kaplan-Meier and Cox proportional hazards. Analyses were stratified by treatment line (first line/salvage) and included multivariable models adjusting for known prognostic factors.
A total of 1026 patients with aUC were identified; 614, 617, and 638 were included in ORR, OS, PFS analyses, respectively. Overall, 150 pts had history of prior intravesical BCG treatment. ORR to ICI was similar between those with and without prior intravesical BCG exposure in both first line and salvage settings (adjusted odds radios 0.55 [P= .08] and 1.65 [P= .12]). OS (adjusted hazard ratios 1.05 [P= .79] and 1.13 [P= .49]) and PFS (adjusted hazard ratios 1.12 [P= .55] and 0.87 [P= .39]) were similar between those with and without intravesical BCG exposure in first line and salvage settings.
Prior intravesical BCG was not associated with differences in response and survival in patients with aUC treated with ICI. Limitations include retrospective nature, lack of randomization, presence of selection and confounding biases. This study provides important preliminary data that prior intravesical BCG exposure may not impact ICI efficacy in aUC.
Immune checkpoint inhibitors improve overall survival in advanced urothelial carcinoma, but response rates remain modest. We performed a multi-institutional retrospective cohort study comparing outcomes (observed response rate, progression-free and overall survival) between patients with and without prior intravesical BCG exposure. All outcomes were similar between the two populations. This study provides preliminary data that prior intravesical BCG exposure does not impact checkpoint inhibitor efficacy.
Details
- Title: Subtitle
- Response and Outcomes to Immune Checkpoint Inhibitors in Advanced Urothelial Cancer Based on Prior Intravesical Bacillus Calmette-Guerin
- Creators
- Rafee Talukder - University of Washington Medical CenterDimitrios Makrakis - University of Washington Medical CenterLeonidas N. Diamantopoulos - University of PittsburghLucia Carril-Ajuria - Hospital Universitario 12 De OctubreDaniel Castellano - Hospital Universitario 12 De OctubreIvan De Kouchkovsky - University of California, San FranciscoVadim S. Koshkin - University of California, San FranciscoJoseph J. Park - University of MichiganAjjai Alva - University of MichiganMehmet A. Bilen - Emory UniversityTyler F. Stewart - University of California San DiegoRana R. McKay - University of California San DiegoVictor S. Santos - University of UtahNeeraj Agarwal - University of UtahJayanshu Jain - University of IowaYousef Zakharia - University of IowaRafael Morales-Barrera - Universitat Autònoma de BarcelonaMichael E. Devitt - University of VirginiaMichael Grant - Imperial College LondonMark P. Lythgoe - Imperial College LondonDavid J. Pinato - Imperial College LondonAriel Nelson - Medical College of WisconsinChristopher J. Hoimes - University Hospitals Seidman Cancer CenterEvan Shreck - Montefiore Medical CenterBenjamin A. Gartrell - Montefiore Medical CenterAlex Sankin - Montefiore Medical CenterAbhishek Tripathi - University of Oklahoma Health Sciences CenterRoubini Zakopoulou - National and Kapodistrian University of AthensAristotelis Bamias - National and Kapodistrian University of AthensJure Murgic - University Hospital Centre ZagrebAna Fröbe - University Hospital Centre ZagrebAlejo Rodriguez-Vida - Hospital Del MarAlexandra Drakaki - University of California, Los AngelesSandy Liu - University of California, Los AngelesVivek Kumar - Brigham and Women's HospitalGiuseppe Di Lorenzo - University of MoliseMonika Joshi - Penn State Milton S. Hershey Medical CenterPedro Isaacsson Velho - Sidney Kimmel Comprehensive Cancer CenterLucia Alonso Buznego - Instituto de Investigación Marqués de ValdecillaIgnacio Duran - Instituto de Investigación Marqués de ValdecillaMarcus Moses - Tulane UniversityPedro Barata - Tulane UniversityGuru Sonpavde - Dana-Farber Cancer InstituteEvan Y. Yu - University of Washington Medical CenterJonathan L. Wright - University of WashingtonPetros Grivas - University of Washington Medical CenterAli Raza Khaki - Stanford University
- Resource Type
- Journal article
- Publication Details
- Clinical genitourinary cancer, Vol.20(2), pp.165-175
- DOI
- 10.1016/j.clgc.2021.12.012
- PMID
- 35078711
- PMCID
- PMC8995351
- NLM abbreviation
- Clin Genitourin Cancer
- ISSN
- 1558-7673
- eISSN
- 1938-0682
- Publisher
- Elsevier Inc
- Grant note
- DOI: 10.13039/100000054, name: NCI
- Language
- English
- Date published
- 04/01/2022
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984544623202771
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