Skip to main content
main-content
Top

08-08-2019 | Urothelial cancer | News

Balance needed for short- vs long-term immunotherapy risks, benefits in mUC

share
SHARE
print
PRINT
insite
SEARCH

medwireNews: Patients with cisplatin-ineligible metastatic urothelial carcinoma (mUC) have decreased short-term overall survival (OS) when receiving immunotherapy versus carboplatin-based chemotherapy in the first line, but increased long-term survival, study findings indicate.

Therefore, “clinicians and patients should carefully consider how to balance the short-term benefit of chemotherapy against the long-term benefit of immunotherapy,” write Emily Feld (University of Pennsylvania, Philadelphia, USA) and co-authors in European Urology.

Feld and team retrospectively reviewed the electronic health records of 2017 US patients (median age 78 years, 73% men) with cisplatin-ineligible mUC receiving first-line carboplatin-based chemotherapy (n=1530) or immunotherapy (single-agent nivolumab, pembrolizumab, atezolizumab, durvalumab, or avelumab; n=487) between 2011 and 2018.

Using inverse probability of treatment weighting (IPTW) to adjust for confounding by factors associated with treatment selection, the researchers found that median OS was 9 months with immunotherapy and 11 months with chemotherapy.

At 12 months, patients in the immunotherapy group had a significant 37% increased likelihood for death relative to those in the chemotherapy group, with IPTW-adjusted OS rates of 39.6% versus 46.1%.

However, among the patients who survived the first 12 months, there was a significant 50% lower risk for death beyond this point with immunotherapy than with chemotherapy. At 36 months, the IPTW-adjusted OS rates were 28.3% and 13.3%, respectively.

The researchers comment that their “observation of decreased short-term survival with immunotherapy is consistent with the preliminary results from data monitoring committees’ early review of two ongoing first-line immunotherapy trials” and may represent a subgroup of patients who either do not respond to immunotherapy or who have hyperprogression.

“Therefore, some populations (eg, those with symptomatic or high-volume disease) may instead benefit from chemotherapy as initial therapy,” they write.

In exploratory analyses the team found that, at 6 months, survival was highest for PD-L1-positive patients and lowest for PD-L1-negative patients treated with immunotherapy versus chemotherapy.

This supports “the EMA and FDA label revision restricting immunotherapy use to mUC patients whose tumors are PD-L1 positive (approximately 30% of all tumors),” the researchers remark.

Feld et al conclude that their “findings of improved short-term survival with carboplatin-based chemotherapy but superior long-term survival with immunotherapy provide a rationale for considering first-line combination of chemotherapy and immunotherapy in an effort to achieve maximal survival for all patients.”

“This is currently being explored in the ongoing trials KEYNOTE-361 and IMVigor-130.”

By Laura Cowen

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Eur Urol 2019; doi:10.1016/j.eururo.2019.07.032

share
SHARE
print
PRINT

ESMO 2022 congress coverage

Access the latest news and expert insight from the 2022 European Society for Medical Oncology Congress

New additions to the Adis Journal Club

A selection of topical peer-reviewed articles from the Adis journals, curated by the editors.