Neoadjuvant Nivolumab-Ipilimumab versus Platinum-Based Chemotherapy in Muscle-Invasive Bladder Cancer: A Single-Institution, Propensity-Weighted Cohort Study.

IF 2.6 4区医学 Q3 ONCOLOGY

Cancer Management and Research Pub Date : 2026-11-01 eCollection Date: 2026-01-01 DOI:10.2147/CMAR.S642002

Li-Hua Huang, Min-Che Tung, Wei-Chun Weng, Chao-Yu Hsu, Yen-Chuan Ou, Chi-Chien Lin

{"title":"Neoadjuvant Nivolumab-Ipilimumab versus Platinum-Based Chemotherapy in Muscle-Invasive Bladder Cancer: A Single-Institution, Propensity-Weighted Cohort Study.","authors":"Li-Hua Huang, Min-Che Tung, Wei-Chun Weng, Chao-Yu Hsu, Yen-Chuan Ou, Chi-Chien Lin","doi":"10.2147/CMAR.S642002","DOIUrl":null,"url":null,"abstract":"Introduction: Neoadjuvant chemotherapy (NAC) is standard for muscle-invasive bladder cancer (MIBC), yet many patients are platinum-ineligible. We compared outcomes of neoadjuvant nivolumab plus ipilimumab versus platinum-based NAC.Methods: This single-institution comparative cohort study compared a prospective immune checkpoint inhibitor (ICI) cohort (n=11) receiving nivolumab (1 mg/kg) plus ipilimumab (3 mg/kg) against a retrospective platinum-based NAC cohort (n=30). Propensity score-based overlap weighting was used to reduce measured confounding. Main outcomes included pathologic complete response (pCR), downstaging (<ypT2N0), and overall survival (OS).Results: Among surgically evaluable patients (ICI n=9; NAC n=30), pCR rates were 22.2% and 26.7%, respectively (p=1.00), and downstaging rates were 44.4% and 50.0% (p=1.00). Propensity-weighted analyses likewise showed no statistically significant differences in pathologic response. In the total ICI cohort (n=11), four patients (36.4%) did not complete all four planned cycles, including three because of grade 3 immune-related toxicity and one who died following an on-treatment acute myocardial infarction. At a median follow-up of 58.3 months in the ICI cohort, no recurrences were observed among the nine surgically treated patients during the available follow-up, compared with nine recurrences (30.0%) in the NAC cohort. Two-year OS was 100% in the ICI group and approximately 80% in the NAC group (log-rank p=0.18).Conclusion: Neoadjuvant dual ICI demonstrated pathologic activity, with response rates numerically within the range observed with standard NAC. Clinically meaningful immune-related adverse events were observed in the ICI cohort; however, no recurrences were observed among surgically treated ICI patients during the available follow-up. These findings support further investigation of dual ICI as a potential option when platinum-based NAC is not feasible or is declined.","PeriodicalId":9479,"journal":{"name":"Cancer Management and Research","volume":"18 ","pages":"642002"},"PeriodicalIF":2.6000,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13738089/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cancer Management and Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/CMAR.S642002","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction: Neoadjuvant chemotherapy (NAC) is standard for muscle-invasive bladder cancer (MIBC), yet many patients are platinum-ineligible. We compared outcomes of neoadjuvant nivolumab plus ipilimumab versus platinum-based NAC.

Methods: This single-institution comparative cohort study compared a prospective immune checkpoint inhibitor (ICI) cohort (n=11) receiving nivolumab (1 mg/kg) plus ipilimumab (3 mg/kg) against a retrospective platinum-based NAC cohort (n=30). Propensity score-based overlap weighting was used to reduce measured confounding. Main outcomes included pathologic complete response (pCR), downstaging (

Results: Among surgically evaluable patients (ICI n=9; NAC n=30), pCR rates were 22.2% and 26.7%, respectively (p=1.00), and downstaging rates were 44.4% and 50.0% (p=1.00). Propensity-weighted analyses likewise showed no statistically significant differences in pathologic response. In the total ICI cohort (n=11), four patients (36.4%) did not complete all four planned cycles, including three because of grade 3 immune-related toxicity and one who died following an on-treatment acute myocardial infarction. At a median follow-up of 58.3 months in the ICI cohort, no recurrences were observed among the nine surgically treated patients during the available follow-up, compared with nine recurrences (30.0%) in the NAC cohort. Two-year OS was 100% in the ICI group and approximately 80% in the NAC group (log-rank p=0.18).

Conclusion: Neoadjuvant dual ICI demonstrated pathologic activity, with response rates numerically within the range observed with standard NAC. Clinically meaningful immune-related adverse events were observed in the ICI cohort; however, no recurrences were observed among surgically treated ICI patients during the available follow-up. These findings support further investigation of dual ICI as a potential option when platinum-based NAC is not feasible or is declined.

查看原文本刊更多论文

新辅助Nivolumab-Ipilimumab与铂基化疗治疗肌肉侵袭性膀胱癌：一项单机构、倾向加权队列研究

新辅助化疗（NAC）是肌肉浸润性膀胱癌（MIBC）的标准治疗方案，但许多患者不符合铂类治疗条件。我们比较了新辅助纳武单抗加伊匹单抗与铂基NAC的结果。方法：这项单机构比较队列研究比较了一个前瞻性免疫检查点抑制剂（ICI）队列（n=11）接受nivolumab (1mg /kg) + ipilimumab （3mg /kg）与一个回顾性铂基NAC队列（n=30）。使用基于倾向得分的重叠加权来减少测量的混淆。主要结局包括病理完全缓解（pCR）、降期(结果：在可手术评估的患者（ICI n=9; NAC n=30）中，pCR率分别为22.2%和26.7% (p=1.00)，降期率分别为44.4%和50.0% （p=1.00）。倾向加权分析同样显示病理反应没有统计学上的显著差异。在整个ICI队列（n=11）中，4名患者（36.4%）没有完成所有4个计划周期，其中3名患者因为3级免疫相关毒性，1名患者死于治疗中的急性心肌梗死。ICI队列的中位随访时间为58.3个月，在可用的随访期间，9例手术治疗的患者中未观察到复发，而NAC队列中有9例复发（30.0%）。ICI组2年OS为100%，NAC组约为80% （log-rank p=0.18）。结论：新辅助双ICI表现出病理活性，其有效率在标准NAC观察到的范围内。在ICI队列中观察到有临床意义的免疫相关不良事件；然而，在可用的随访期间，未观察到手术治疗的ICI患者复发。这些发现支持进一步研究双ICI作为潜在的选择，当铂基NAC不可行或被拒绝。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Cancer Management and Research Medicine-Oncology

CiteScore

7.40

自引率

0.00%

发文量

448

审稿时长

16 weeks

期刊介绍： Cancer Management and Research is an international, peer reviewed, open access journal focusing on cancer research and the optimal use of preventative and integrated treatment interventions to achieve improved outcomes, enhanced survival, and quality of life for cancer patients. Specific topics covered in the journal include: ◦Epidemiology, detection and screening ◦Cellular research and biomarkers ◦Identification of biotargets and agents with novel mechanisms of action ◦Optimal clinical use of existing anticancer agents, including combination therapies ◦Radiation and surgery ◦Palliative care ◦Patient adherence, quality of life, satisfaction The journal welcomes submitted papers covering original research, basic science, clinical & epidemiological studies, reviews & evaluations, guidelines, expert opinion and commentary, and case series that shed novel insights on a disease or disease subtype.