Makrakis et al. collected data from 25 United States and Europe institutions for 917 patients with advanced urothelial carcinoma who were treated with immune checkpoint inhibitors between 2013 and 2021. Lymph node metastases were present in 72% and 79% of patients, liver metastasis were present in 17% and 25% and lung metastasis were present in 22% and 32% of patients receiving first-line versus second-line immune checkpoint inhibitor treatment, respectively. The presence of liver or bone metastasis was associated with shorter progression-free survival in both first- and second-line immune checkpoint inhibitor treatments. In the second-line setting, liver, lung, or bone metastases were associated with shorter progression-free survival.
Overall, patients with lymph node-confined metastasis treated with first- or second-line immune checkpoint inhibitors had a significantly longer overall survival rate than those with other sites of metastases. In contrast, bone, liver, and lung metastases were significantly associated with shorter overall survival in the first- and second-line treatment setting. There was no significant interaction between the metastatic sites.
The mechanisms underlying these findings have yet to be characterized. While the lymph nodes are anatomically the first stations for metastatic spread of bladder cancer, another potential explanation is related to the presence of immune cells in lymph node-confined metastasis compared to the other sites of metastasis which plays a crucial role in response to immune checkpoint inhibitors.
Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York City, New York
References:
- Makrakis D, Talukder R, Lin GI, et al. Association Between Sites of Metastasis and Outcomes With Immune Checkpoint Inhibitors in Advanced Urothelial Carcinoma. Clinical Genitourinary Cancer. 2022;14:41. Published 28 June 2022. https://doi.org/10.1016/j.clgc.2022.06.001.
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