ESMO 2017: Outcomes of patients with metastatic urothelial carcinoma with exclusive bone metastases: Focus on a special patient population

Madrid, Spain ( Patients with metastatic urothelial carcinoma with exclusive bone metastatic spread represent a rare subgroup of patients with unique clinical features. These patients deserve special consideration, as they are usually excluded from clinical trials due to the lack of measurable disease according to RECIST criteria. At today’s poster session at ESMO 2017, Dr. Andrea Necchi and colleagues focused on these patient’s access to treatment and outcomes.

For this retrospective study, 128 cases (6.7%) were extracted from the pool of 1,911 patients with a diagnosis of metastatic urothelial carcinoma from the RISC database. Data from 23 centers was collected. Results of first-line, platinum-based chemotherapy in bone-only metastatic patients were compared with those from the remaining patients in the RISC database. Summary statistics were used to describe patient characteristics and outcomes. The Kaplan-Meier method was used to estimate time to event outcomes such as progression-free survival (PFS) and overall survival (OS). Both OS and PFS were measured from the date of diagnosis of metastatic disease. Univariable and multivariable Cox analyses were performed.

Among the 128 evaluable metastatic urothelial carcinoma patients treated between February 1997 and April 2013, ECOG performance status was ≥1 in 85.9% vs. 66.3% of the remaining patients from RISC database. Seventy-three (57%) patients received first-line chemotherapy, which was platinum-based in all patients, and 28 patients (38.4%) receiving second-line chemotherapy (vs. 75.8% and 42.5%, respectively, from the RISC database). On multivariable analyses, chemotherapy administration was associated with improved OS among bone-only metastatic urothelial carcinoma patients (HR 0.90, 95%CI 0.48-1.68), although not statistically significant. Among platinum-treated patients (total evaluable n = 972), significantly-different PFS and OS estimates were observed according to the bone metastases status (no bone metastases vs. bone metastases only vs. bone + other metastases, p < 0.001). 2-year PFS was: 37.4%, 28.8%, 25.9% for bone metastases, bone metastases only, and bone + other metastases, respectively. Furthermore, 2-year OS was: 35.5%, 15.8%, 23.0%, for bone metastases, bone metastases only, and bone + other metastases, respectively.

The authors concluded that patients with bone only metastases are less likely to receive systemic therapy than patients with metastases to other sites, likely due to worse performance status. The prognostic impact of having exclusive bone metastases or additional sites seems to be equally poor. Clinical trials with new agents should focus on including this at-risk patient population.

Speaker: Andrea Necchi, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

Co-Authors: G. R. Pond (Hamilton, Canada) S. K. Pal (Duarte, United States of America) N. Agarwal (Salt Lake City, United States of America) D. Bowles (South Aurora, United States of America) E. Plimack (Philadelphia, United States of America) E. Y. Yu (Seattle, United States of America) S. Ladoire (Dijon, France) J. Baniel (Petach Tikva, Israel) S. Crabb (Southampton, United Kingdom) G. Niegisch (Düsseldorf, Germany) A. Golshayan (Charleston, United States of America) S. Sridhar (Toronto, Canada) D. Berthold (Lausanne, Switzerland) J. E. Rosenberg (New York, United States of America) T. Powles (London, United Kingdom) A. Bamias (Athens, Greece) L. C. Harshman (Boston, United States of America) J. Bellmunt (Boston, MA, United States of America) M. D. Galsky (New York, United States of America)

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, Twitter: @zklaassen_md at the European Society for Medical Oncology Annual Congress - September 8 - 12, 2017 - Madrid, Spain