Association Between Early on-Treatment Weight Loss With Enfortumab Vedotin Plus Pembrolizumab and Survival in Advanced Urothelial Carcinoma

IF 2.4 3区医学 Q3 ONCOLOGY

Clinical genitourinary cancer Pub Date : 2025-12-01 Epub Date: 2025-08-17 DOI:10.1016/j.clgc.2025.102417

Ryan D. Chow, Ronac Mamtani

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引用次数: 0

Abstract

Background

Combination therapy with enfortumab vedotin plus pembrolizumab (EV+P) is now the preferred first-line (1L) therapy for advanced urothelial carcinoma (aUC), but prognostic indicators for patients on 1L EV+P have not yet been described.

Patients and Methods

We conducted a retrospective cohort study of patients receiving 1L EV+P for aUC. We analyzed deidentified electronic health record data from the Flatiron Health database to identify adults with aUC who initiated EV+P between April 3, 2023 and December 31, 2024. Inclusion required absence of death, disease progression, or second line therapy start within 30 days of EV+P initiation, as well as documented weight measurements at the time of EV+P initiation (i.e., day 0) and day 28. We used Cox proportional hazards modeling with stabilized inverse probability treatment weighting (IPTW) to evaluate the association of early on-treatment weight loss with overall survival (OS), progression-free survival (PFS), and time to EV discontinuation.

Results

A total of 401 patients met study criteria. Of these, 78 patients (19.5%) experienced ≥ 5% weight loss by day 28 following EV+P initiation. Early on-treatment weight loss was associated with inferior OS (median 12.8 vs. 20.4 months; IPTW-adjusted HR [aHR] = 2.04 [1.41-2.95], P = 1.9 × 10^-4), but not with PFS (aHR = 1.22 [0.89-1.65], P = .22) or time to EV discontinuation (aHR = 1.30 [0.96-1.77], P = .090). The association of early on-treatment weight loss with OS was conserved in subgroup analyses stratifying patients by baseline albumin or BMI.

Conclusion

Early weight loss ≥5% occurred in one fifth of patients receiving 1L EV+P treatment and was associated with inferior overall survival.

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在晚期尿路上皮癌患者中，早期使用依福图单抗-维多汀联合派姆单抗治疗减肥与生存率的关系

背景：目前，对晚期尿路上皮癌（aUC）的首选一线（1L）治疗是用enfortumab vedotin + pembrolizumab （EV+P）联合治疗，但使用1L EV+P的患者的预后指标尚未被描述。患者和方法：我们对接受1L EV+P治疗aUC的患者进行了回顾性队列研究。我们分析了来自Flatiron health数据库的未识别电子健康记录数据，以识别在2023年4月3日至2024年12月31日期间开始使用EV+P的aUC成人。纳入要求在EV+P开始30天内没有死亡、疾病进展或开始二线治疗，以及在EV+P开始时（即第0天）和第28天记录的体重测量。我们使用具有稳定逆概率治疗加权（IPTW）的Cox比例风险模型来评估早期治疗体重减轻与总生存期（OS）、无进展生存期（PFS）和停药时间的关系。结果：共有401例患者符合研究标准。其中，78名患者（19.5%）在EV+P启动后第28天体重减轻≥5%。治疗早期体重减轻与较差的OS相关（中位12.8 vs. 20.4个月；经iptwr调整的HR [aHR] = 2.04 [1.41-2.95], P = 1.9 × 10-4），但与PFS （aHR = 1.22 [0.89-1.65], P = 0.22）或停药时间（aHR = 1.30 [0.96-1.77], P = 0.090）无关。在以基线白蛋白或BMI对患者进行分层的亚组分析中，早期治疗体重减轻与OS的关联是保守的。结论：接受1L EV+P治疗的患者中，早期体重减轻≥5%的患者占五分之一，且与总生存期较差相关。

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.