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Response and Outcomes to Immune Checkpoint Inhibitors in Advanced Urothelial Cancer Based on Prior Intravesical Bacillus Calmette-Guerin
- Source :
- Clinical genitourinary cancer, vol 20, iss 2, Clin Genitourin Cancer
- Publication Year :
- 2022
- Publisher :
- eScholarship, University of California, 2022.
-
Abstract
- Background: Immune checkpoint inhibitors (ICI) improve overall survival (OS) in patients with locally advanced, unresectable, or metastatic urothelial carcinoma (aUC), but response rates can be modest. We compared outcomes between patients with and without prior intravesical Bacillus Calmette-Guerin (BCG), who received ICI for aUC, hypothesizing that prior intravesical BCG would be associated with worse outcomes. Patients and methods: We performed a retrospective cohort study across 25 institutions in US and Europe. We compared observed response rate (ORR) using logistic regression ; progression-free survival (PFS) and OS using Kaplan-Meier and Cox proportional hazards. Analyses were stratified by treatment line (first line/salvage) and included multivariable models adjusting for known prognostic factors. Results: A total of 1026 patients with aUC were identified ; 614, 617, and 638 were included in ORR, OS, PFS analyses, respectively. Overall, 150 pts had history of prior intravesical BCG treatment. ORR to ICI was similar between those with and without prior intravesical BCG exposure in both first line and salvage settings (adjusted odds radios 0.55 [P= .08] and 1.65 [P= .12]). OS (adjusted hazard ratios 1.05 [P= .79] and 1.13 [P= .49]) and PFS (adjusted hazard ratios 1.12 [P= .55] and 0.87 [P= .39]) were similar between those with and without intravesical BCG exposure in first line and salvage settings. Conclusion: Prior intravesical BCG was not associated with differences in response and survival in patients with aUC treated with ICI. Limitations include retrospective nature, lack of randomization, presence of selection and confounding biases. This study provides important preliminary data that prior intravesical BCG exposure may not impact ICI efficacy in aUC.
- Subjects :
- BCG
bladder cancer
immunotherapy
outcomes
urinary tract neoplasms
Urology
Oncology and Carcinogenesis
Outcomes
Article
Adjuvants, Immunologic
Immunologic
Clinical Research
Humans
Adjuvants
Oncology & Carcinogenesis
Immune Checkpoint Inhibitors
Retrospective Studies
Cancer
Carcinoma, Transitional Cell
Intravesical
Carcinoma
Bladder cancer
Evaluation of treatments and therapeutic interventions
Administration, Intravesical
Neoplasm Recurrence
Good Health and Well Being
Oncology
Local
Urinary Bladder Neoplasms
6.1 Pharmaceuticals
Administration
BCG Vaccine
Public Health and Health Services
HIV/AIDS
Urinary tract neoplasms
Immunotherapy
Neoplasm Recurrence, Local
Transitional Cell
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- Clinical genitourinary cancer, vol 20, iss 2, Clin Genitourin Cancer
- Accession number :
- edsair.doi.dedup.....2e77cc9c27e1a3725c9bb47e228d859c