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Response Rate to Chemotherapy After Immune Checkpoint Inhibition in Metastatic Urothelial Cancer
European Urology ( IF 23.4 ) Pub Date : 2017-09-13 , DOI: 10.1016/j.eururo.2017.08.022
Bernadett Szabados , Nick van Dijk , Yen Zhi Tang , Michiel S. van der Heijden , Akhila Wimalasingham , Alfonso Gomez de Liano , Simon Chowdhury , Simon Hughes , Sarah Rudman , Mark Linch , Thomas Powles

Immune checkpoint inhibitors (ICIs) are active in metastatic urothelial carcinoma (MUC). They have joined chemotherapy (CT) as a standard of care. Here, we investigate the activity of CT after progression on ICIs. Two cohorts of sequential patients with MUC were described (n = 28). Cohort A received first-line ICIs followed by CT after progression. Cohort B received CT after failure of first-line platinum-based CT followed by ICIs. Response rate (RR) to CT was assessed using Response Evaluation Criteria in Solid Tumors (RECIST v1.1) by a designated radiologist. Best RR for cohort A was 64%. Two patients experienced clinical progression and died before the first radiographic assessment. RR for cohort B was 21%, which was significantly lower than that for cohort A. Progression of disease occurred in 43% of cohort B patients by the end of CT. These data suggest a lack of cross resistance between CT and ICIs in MUC. Therefore, the sequencing of these drugs is likely to be important to maximise outcomes. This is particularly true after first-line ICIs as subsequent CT has significant activity.

Patient summary

In this report, we studied the effect of chemotherapy in metastatic bladder cancer, which relapsed after immune checkpoint inhibitors. We found that the activity of chemotherapy was maintained despite previous exposure to immune therapy. This underlines the importance of sequencing these agents to maximise outcomes.



中文翻译:

转移性尿路上皮癌免疫检查点抑制后对化疗的反应率

免疫检查点抑制剂(ICIs)在转移性尿路上皮癌(MUC)中起作用。他们加入了化疗(CT)作为护理标准。在这里,我们调查ICIs进展后CT的活动。描述了两个连续的MUC患者(n = 28)。队列A接受一线ICI,进展后接受CT检查。队列B在一线铂基CT失败后继之以ICI后接受了CT。指定的放射科医生使用《实体瘤反应评估标准》(RECIST v1.1)评估对CT的反应率(RR)。A组的最佳RR为64%。两名患者经历了临床进展并在首次影像学评估之前死亡。B组的RR为21%,显着低于A组。到CT结束时,43%的B组患者发生了疾病进展。这些数据表明在MUC中CT和ICI之间缺乏交叉抗性。因此,对这些药物进行测序可能对最大化结果至关重要。一线ICI后尤其如此,因为随后的CT具有明显的活性。

病人总结

在本报告中,我们研究了化学疗法在转移性膀胱癌中的作用,该作用在免疫检查点抑制剂后复发。我们发现尽管先前曾接受免疫治疗,但化学疗法的活性得以维持。这强调了对这些药物进行测序以最大化结果的重要性。

更新日期:2017-09-13
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