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Article Dans Une Revue European Journal of Cancer Année : 2022

Chemotherapy following immune checkpoint inhibitors in patients with locally advanced or metastatic urothelial carcinoma

Lucie Meynard
  • Fonction : Auteur
Blandine Delaunay
  • Fonction : Auteur
Aude Flechon
  • Fonction : Auteur
Carolina Saldana
  • Fonction : Auteur
Felix Lefort
  • Fonction : Auteur
Antoine Thiery-Vuillemin
  • Fonction : Auteur
Mathilde Cancel
  • Fonction : Auteur
Elodie Coquan
  • Fonction : Auteur
Sylvain Ladoire
  • Fonction : Auteur
Denis Maillet
  • Fonction : Auteur
Frederic Rolland
  • Fonction : Auteur
Elouen Boughalem
  • Fonction : Auteur
Sophie Martin
  • Fonction : Auteur
Mathieu Laramas
  • Fonction : Auteur
Laurence Crouzet
  • Fonction : Auteur
Baptiste Abbar
  • Fonction : Auteur
Sabrina Falkowski
  • Fonction : Auteur
Damien Pouessel
  • Fonction : Auteur
Guilhem Roubaud
  • Fonction : Auteur

Résumé

BACKGROUND: Recent studies suggest improvements in response to salvage chemotherapy (CT) after immune checkpoint inhibitors (ICIs) in several types of cancer. Our objective was to assess the efficacy of chemotherapy re-challenge after ICI, compared with second-line chemotherapy without previous ICI in patients with locally advanced or metastatic urothelial carcinoma (la/mUC). METHODS: In this multicentre retrospective study, we included all patients with la/mUC initiating second or third-line chemotherapy from January 2015 to June 2020. We compared patients treated with second-line chemotherapy without previous ICI (CT2) and patients treated with third-line chemotherapy after ICI (CT3). The primary end-point was objective response rate (ORR) in CT3 compared with CT2. Secondary end-points included progression-free survival (PFS) and toxicities. RESULTS: Overall, 553 patients were included. ORRs were 31.0% (95% CI, 26.5 to 35.5) and 29.2% (95% CI, 21.9 to 36.6), respectively, in CT2 and CT3, with no statistically significant differences (P = 0.62). In subgroup analyses, no differences in ORR were observed by Bellmunt risk group, type of chemotherapy (platinum or taxanes), duration of response to first-platinum-based chemotherapy (< or ≥ 12 months) or FGFR-status. Median PFS was 4.6 months (95% CI, 3.9 to 5.1) and 4.9 months (95% CI, 4.1 to 5.5) in CT2 and CT3, respectively, and grade 3-4 hematologic toxicity occurred in 35.0% and 22.4% of patients. CONCLUSION: This large multicentre retrospective study provides clinically relevant real-world data. Chemotherapy re-challenge after ICI in la/mUC achieves ORR and PFS comparable with those obtained in CT2 with an acceptable safety profile. These updated results offer more promising outcomes than historically reported with second-line chemotherapy data.
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Dates et versions

hal-03836416 , version 1 (02-11-2022)

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Lucie Meynard, Derek Dinart, Blandine Delaunay, Aude Flechon, Carolina Saldana, et al.. Chemotherapy following immune checkpoint inhibitors in patients with locally advanced or metastatic urothelial carcinoma. European Journal of Cancer, 2022, 175, pp.43-53. ⟨10.1016/j.ejca.2022.08.014⟩. ⟨hal-03836416⟩
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