Isolated Urinary Tract Persistence or Progression in Patients Treated With Immunotherapy for Advanced Urothelial Carcinoma

IF 2.3 3区医学 Q3 ONCOLOGY

Clinical genitourinary cancer Pub Date : 2025-02-06 DOI:10.1016/j.clgc.2025.102312

Pierre-Etienne Gabriel , Hélène Gauthier , Evanguelos Xylinas , Jean-François Hermieu , François Desgrandchamps , Christophe Hennequin , Stéphane Culine , Alexandra Masson-Lecomte , Clément Dumont

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引用次数: 0

Abstract

Purpose

Emerging therapies including anti-PD-(L)1 immunotherapy have changed paradigms of treatment and improved oncological outcomes of advanced/metastatic urothelial carcinoma (mUC) patients. An emerging challenge in this setting is the management of isolated urinary tract persistence or progression (IUTP) of primary urothelial tumor despite stability or response of metastatic disease to immunotherapy.

Methods

This retrospective monocentric study included all patients treated with single-agent anti-PD-(L)1 for mUC between August 2015 and October 2023. Patients were divided in cohorts of interest depending on primary UC site (lower or upper tract) and previous surgery at the time of immunotherapy initiation. Incidence of IUTP was analyzed in a competitive-risk fashion.

Results

Overall,107 patients with mUC and no previous surgical treatment of primary tumor treated with immunotherapy were at risk of local progression. Among 65 mUC with an untreated bladder primary site, the cumulative incidence rate of IUTP in patients with nonprogressive metastatic disease on immunotherapy was 21.4% and 42.7% at 1 and 2 years, respectively. In responders, half of IUTP were nonmuscle invasive;5 patients, including all 3 with NMIBC, remained free of distant progression after a median follow-up of 12.7 (4.6-41.2) months. In mUTUC, 2 out of 18 patients (11.1%) experienced isolated primary site progression and underwent radical nephroureterectomy, with one patient remaining free of distant progression over 1 year.

Conclusions

These preliminary results show high incidence of IUTP as a progression pattern in mUC patients with clinical benefit of immunotherapy for mUC, highlighting the interest of monitoring the primary tumor and considering local treatment in selected cases, with promising oncological outcomes.

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免疫治疗晚期尿路上皮癌患者的孤立尿路持续或进展

目的：包括抗pd -(L)1免疫疗法在内的新兴疗法已经改变了晚期/转移性尿路上皮癌（mUC）患者的治疗模式并改善了肿瘤预后。在这种情况下，一个新出现的挑战是管理孤立尿路持续性或进展（IUTP）原发性尿路上皮肿瘤，尽管转移性疾病对免疫治疗的稳定性或反应。方法本回顾性单中心研究纳入2015年8月至2023年10月期间接受单药抗pd -(L)1治疗mUC的所有患者。患者根据原发性UC部位（下尿路或上尿路）和免疫治疗开始时的既往手术分为感兴趣的队列。以竞争风险的方式分析IUTP的发生率。结果107例mUC原发肿瘤未行手术治疗的患者接受免疫治疗后存在局部进展风险。在65例膀胱原发部位未经治疗的mUC中，接受免疫治疗的非进展性转移性疾病患者的IUTP累积发病率在1年和2年分别为21.4%和42.7%。在应答者中，一半的IUTP是非肌肉侵入性的；5名患者，包括所有3名NMIBC患者，在中位随访12.7（4.6-41.2）个月后仍无远处进展。在mUTUC中，18名患者中有2名（11.1%）经历了孤立的原发部位进展，并接受了根治性肾输尿管切除术，其中1名患者在1年内没有远处进展。结论这些初步结果表明，IUTP作为mUC患者的一种高发病率的进展模式，具有mUC免疫治疗的临床益处，强调了监测原发肿瘤和考虑局部治疗的重要性，并在选定的病例中具有良好的肿瘤预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical genitourinary cancer 医学-泌尿学与肾脏学

CiteScore

5.20

自引率

6.20%

发文量

201

审稿时长

54 days

期刊介绍： Clinical Genitourinary Cancer is a peer-reviewed journal that publishes original articles describing various aspects of clinical and translational research in genitourinary cancers. Clinical Genitourinary Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of genitourinary cancers. The main emphasis is on recent scientific developments in all areas related to genitourinary malignancies. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.