To examine patient and disease characteristics, toxicity, and clinical outcomes for patients with advanced urothelial carcinoma (aUC) who are rechallenged with immune checkpoint inhibitor (ICI)-based therapy.
In this retrospective cohort, we included patients treated with ICI for aUC after having prior ICI treatment. Endpoints included the evaluation of radiographic response and disease control rates with first and second ICI courses, outcomes based on whether there was a change in ICI class (anti-PD-1 vs. anti-PD-L1), and assessment of the reasons for ICI discontinuation.
We identified 25 patients with aUC from 9 institutions who received 2 separate ICI courses. ORR with first ICI and second ICI were 39% and 13%, respectively. Most patients discontinued first ICI due to progression (n = 19) or treatment-related toxicity (n = 4). Thirteen patients received non-ICI treatment between the first and second ICI, and 12 patients changed ICI class (anti-PD-1 vs. anti-PD-L1) at rechallenge. Among 10 patients who changed ICI class, 8 (80%) had progressive disease as best response with second ICI, while among 12 patients re-treated with the same ICI class, only 3 (25%) had progressive disease as best response at the time of rechallenge. With second ICI, most patients discontinued treatment due to progression (n = 18) or patient preference (n = 2).
A proportion of patients with aUC rechallenged with ICI-based regimens may achieve disease control, supporting clinical trials in that setting, especially with ICI-based combinations. Future studies are needed to validate our results and should also focus on identifying biomarkers predictive of benefit with ICI rechallenge.
Clinical genitourinary cancer. 2022 Nov 13 [Epub ahead of print]
Dimitrios Makrakis, Dimitra Rafailia Bakaloudi, Rafee Talukder, Genevieve Ihsiu Lin, Leonidas N Diamantopoulos, Tanya Jindal, Naomi Vather-Wu, Yousef Zakharia, Nishita Tripathi, Neeraj Agarwal, Scott Dawsey, Shilpa Gupta, Eric Lu, Alexandra Drakaki, Sandy Liu, Roubini Zakopoulou, Aristotelis Bamias, Claudia-Maria Fulgenzi, Alessio Cortellini, David Pinato, Pedro Barata, Petros Grivas, Ali Raza Khaki, Vadim S Koshkin
Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA., Department of Epidemiology, University of Washington, Seattle, WA., Department of Medicine, University of Pittsburgh, Pittsburgh, PA., Helen Diller Family Cancer Center, University of California, San Francisco, San Francisco, CA., Department of Medicine, University of Iowa, Iowa City, IA., Division of Oncology, Department of Medicine, University of Iowa, Iowa City, IA., Division of Oncology, Department of Medicine, University of Utah, Salt Lake City, UT., Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH., Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA., 2nd Propaedeutic Department of Internal Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece., Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London; Department of Medical Oncology, University Campus Bio-Medico of Rome, Italy., Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London; Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy., Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy., Tulane Medical School, New Orleans, LA; University Hospitals Seidman Cancer Center, Cleveland, OH., Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA., Division of Oncology, Department of Medicine, Stanford University, Stanford, CA., Division of Hematology/Oncology, Department of Medicine, Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/36481176