New prognostic model in patients with advanced urothelial carcinoma treated with second-line immune checkpoint inhibitors
Background Bellmunt Risk Score, based on Eastern Cooperative Oncology Group (ECOG) performance status (PS), hemoglobin levels and presence of liver metastases, is the most established prognostic algorithm for patients with advanced urothelial cancer (aUC) progressing after platinum-based chemotherap...
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BMJ Publishing Group
2023-01-01
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| Series: | Journal for ImmunoTherapy of Cancer |
| Online Access: | https://jitc.bmj.com/content/11/1/e005977.full |
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| author | Ernest Choy Yohann Loriot Fabio Calabrò Cora N Sternberg Guillermo De Velasco Daniel Castellano Roubini Zakopoulou Aristotelis Bamias Nicholas James Axel Merseburger F Lopez-Rios Mario Kramer Kimon Tzannis |
| author_facet | Ernest Choy Yohann Loriot Fabio Calabrò Cora N Sternberg Guillermo De Velasco Daniel Castellano Roubini Zakopoulou Aristotelis Bamias Nicholas James Axel Merseburger F Lopez-Rios Mario Kramer Kimon Tzannis |
| author_sort | Ernest Choy |
| collection | DOAJ |
| description | Background Bellmunt Risk Score, based on Eastern Cooperative Oncology Group (ECOG) performance status (PS), hemoglobin levels and presence of liver metastases, is the most established prognostic algorithm for patients with advanced urothelial cancer (aUC) progressing after platinum-based chemotherapy. Nevertheless, existing algorithms may not be sufficient following the introduction of immunotherapy. Our aim was to develop an improved prognostic model in patients receiving second-line atezolizumab for aUC.Methods Patients with aUC progressing after cisplatin/carboplatin-based chemotherapy and enrolled in the prospective, single-arm, phase IIIb SAUL study were included in this analysis. Patients were treated with 3-weekly atezolizumab 1200 mg intravenously. The development and internal validation of a prognostic model for overall survival (OS) was performed using Cox regression analyses, bootstrapping methods and calibration.Results In 936 patients, ECOG PS, alkaline phosphatase, hemoglobin, neutrophil-to-lymphocyte ratio, liver metastases, bone metastases and time from last chemotherapy were identified as independent prognostic factors. In a 4-tier model, median OS for patients with 0–1, 2, 3–4 and 5–7 risk factors was 18.6, 10.4, 4.8 and 2.1 months, respectively. Compared with Bellmunt Risk Score, this model provided enhanced prognostic separation, with a c-index of 0.725 vs 0.685 and increment in c-statistic of 0.04 (p<0.001). Inclusion of PD-L1 expression did not improve the model.Conclusions We developed and internally validated a prognostic model for patients with aUC receiving postplatinum immunotherapy. This model represents an improvement over the Bellmunt algorithm and could aid selection of patients with aUC for second-line immunotherapy.Trial registration number NCT02928406. |
| format | Article |
| id | doaj-art-a82e3f41ebdc4c3989d1f4211495a2b2 |
| institution | Kabale University |
| issn | 2051-1426 |
| language | English |
| publishDate | 2023-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Journal for ImmunoTherapy of Cancer |
| spelling | doaj-art-a82e3f41ebdc4c3989d1f4211495a2b22025-01-29T11:20:10ZengBMJ Publishing GroupJournal for ImmunoTherapy of Cancer2051-14262023-01-0111110.1136/jitc-2022-005977New prognostic model in patients with advanced urothelial carcinoma treated with second-line immune checkpoint inhibitorsErnest Choy0Yohann Loriot1Fabio Calabrò2Cora N Sternberg3Guillermo De Velasco4Daniel Castellano5Roubini Zakopoulou6Aristotelis Bamias7Nicholas James8Axel Merseburger9F Lopez-Rios10Mario Kramer11Kimon Tzannis12Cardiff University, Cardiff, UK3Gustave Roussy, Villejuif, FranceGU Oncology Unit, San Camillo Forlanini Hospital, Roma, ItalyHematology and Oncology Englander Institute for Precision Medicine Weill Cornell Medicine, New York, New York, USAHospital Universitario 12 de Octubre, Madrid, SpainHospital Universitario 12 de Octubre, Madrid, SpainUniversity of Athens, Athens, Greece2National and Kapodistrian University of Athens, ATHENS, GreeceRoyal Marsden Hospital NHS Trust, London, UKUniversity Clinic Schleswig-Holstein-Lubeck, Lübeck, GermanyHospital Universitario HM Sanchinarro, Madrid, SpainUniversity Clinic Schleswig-Holstein-Lubeck, Lübeck, GermanyNational and Kapodistrian University of Athens, Athens, GreeceBackground Bellmunt Risk Score, based on Eastern Cooperative Oncology Group (ECOG) performance status (PS), hemoglobin levels and presence of liver metastases, is the most established prognostic algorithm for patients with advanced urothelial cancer (aUC) progressing after platinum-based chemotherapy. Nevertheless, existing algorithms may not be sufficient following the introduction of immunotherapy. Our aim was to develop an improved prognostic model in patients receiving second-line atezolizumab for aUC.Methods Patients with aUC progressing after cisplatin/carboplatin-based chemotherapy and enrolled in the prospective, single-arm, phase IIIb SAUL study were included in this analysis. Patients were treated with 3-weekly atezolizumab 1200 mg intravenously. The development and internal validation of a prognostic model for overall survival (OS) was performed using Cox regression analyses, bootstrapping methods and calibration.Results In 936 patients, ECOG PS, alkaline phosphatase, hemoglobin, neutrophil-to-lymphocyte ratio, liver metastases, bone metastases and time from last chemotherapy were identified as independent prognostic factors. In a 4-tier model, median OS for patients with 0–1, 2, 3–4 and 5–7 risk factors was 18.6, 10.4, 4.8 and 2.1 months, respectively. Compared with Bellmunt Risk Score, this model provided enhanced prognostic separation, with a c-index of 0.725 vs 0.685 and increment in c-statistic of 0.04 (p<0.001). Inclusion of PD-L1 expression did not improve the model.Conclusions We developed and internally validated a prognostic model for patients with aUC receiving postplatinum immunotherapy. This model represents an improvement over the Bellmunt algorithm and could aid selection of patients with aUC for second-line immunotherapy.Trial registration number NCT02928406.https://jitc.bmj.com/content/11/1/e005977.full |
| spellingShingle | Ernest Choy Yohann Loriot Fabio Calabrò Cora N Sternberg Guillermo De Velasco Daniel Castellano Roubini Zakopoulou Aristotelis Bamias Nicholas James Axel Merseburger F Lopez-Rios Mario Kramer Kimon Tzannis New prognostic model in patients with advanced urothelial carcinoma treated with second-line immune checkpoint inhibitors Journal for ImmunoTherapy of Cancer |
| title | New prognostic model in patients with advanced urothelial carcinoma treated with second-line immune checkpoint inhibitors |
| title_full | New prognostic model in patients with advanced urothelial carcinoma treated with second-line immune checkpoint inhibitors |
| title_fullStr | New prognostic model in patients with advanced urothelial carcinoma treated with second-line immune checkpoint inhibitors |
| title_full_unstemmed | New prognostic model in patients with advanced urothelial carcinoma treated with second-line immune checkpoint inhibitors |
| title_short | New prognostic model in patients with advanced urothelial carcinoma treated with second-line immune checkpoint inhibitors |
| title_sort | new prognostic model in patients with advanced urothelial carcinoma treated with second line immune checkpoint inhibitors |
| url | https://jitc.bmj.com/content/11/1/e005977.full |
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