Daniele Raggi1, Patrizia Giannatempo2, Laura Marandino2, Francesco Pierantoni3, Marco Maruzzo3, Helga Lipari4, Giuseppe L Banna4, Ugo De Giorgi5, Chiara Casadei5, Emanuele Naglieri6, Sebastiano Buti7, Melissa Bersanelli7, Marco Stellato8, Daniele Santini8, Francesca Vignani9, Giandomenico Roviello10, Antonello Veccia11, Orazio Caffo11, Tania Losanno12, Fabrizio Calabrò12, Claudia Mucciarini13, Sandro Pignata14, Andrea Necchi15, Massimo Di Maio9. 1. Department of Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: raggi.daniele@hsr.it. 2. Department of Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 3. Department of Oncology, Istituto Oncologico Veneto, Padova, Italy. 4. Department of Oncology, Medical Oncology Cannizzaro Hospital, Catania, Italy. 5. Department of Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy. 6. Department of Oncology, Policlinico di Bari Ospedale Giovanni XXIII, Bari, Italy. 7. Department of Oncology, University Hospital of Parma, Parma, Italy. 8. Department of Oncology, Policlinico Universitario Campus Bio-Medico, Rome, Italy. 9. Department of Oncology, University of Turin, Mauriziano Umberto I Hospital, Turin, Italy. 10. Department of Oncology, Azienda ospedaliero-universitaria Careggi, Florence, Italy. 11. Department of Oncology, Santa Chiara Hospital, Trento, Italy. 12. Department of Oncology, San Camillo Forlanini Hospital, Rome, Italy. 13. Medical Oncology Unit, Ramazzini Hospital, Carpi, Italy. 14. Department of Urology and Gynecology, Oncologia Medica Uro-Ginecologica, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy. 15. Deptartment of Oncology from Vita-Salute University IRCCS San Raffaele, Milan, Italy.
Abstract
BACKGROUND: Considerable numbers of patients with metastatic urothelial carcinoma (mUC) develop bone metastases (BoM). Their impact on the efficacy of immune-checkpoint inhibitors (ICIs) is not yet investigated. METHODS: Between July 2014 and August 2020 data on pts treated with single-agent ICIs after failure of at least 1 previous line of chemotherapy for advanced disease, were retrospectively collected across 14 Italian centers. Overall survival (OS) and progression-free survival (PFS) were analyzed using the Kaplan-Meier method. Cox regression analysis was performed evaluating potential prognostic factors for OS and PFS. Each factor was evaluated in univariable (UVA) and multivariable analysis (MVA). RESULTS: A total of 208 evaluable patients treated with ICIs were identified, including 122 (59%) without BoM (BoM-) and 86 (41%) with bone metastases (BoM+). After a median follow-up of 22.3 months, BoM+ patients showed shorter OS (median 3.9 vs 7.8 months, HR 1.59 [95%CI, 1.15-2.20], P = .005) and shorter PFS (median 2.0 vs 2.6 months, HR 1.76 [95%CI, 1.31-2.37], P < .001). Probability of being alive was 62% vs 40% after 6 months, 38% vs 23% after 1 year and 24% vs 13% after 2 years, in BoM- and BoM+ respectively. Within each Bellmunt score, OS and PFS of BoM+ patients were shorter. Both presence of BoM and higher Bellmunt risk score were significantly associated with shorter OS and PFS in UVA and MVA. CONCLUSION: Patients treated with single-agent ICIs for BoM+ mUC have a dismal prognosis compared to BoM-. Further research is needed to understand the mechanism behind these outcomes.
BACKGROUND: Considerable numbers of patients with metastatic urothelial carcinoma (mUC) develop bone metastases (BoM). Their impact on the efficacy of immune-checkpoint inhibitors (ICIs) is not yet investigated. METHODS: Between July 2014 and August 2020 data on pts treated with single-agent ICIs after failure of at least 1 previous line of chemotherapy for advanced disease, were retrospectively collected across 14 Italian centers. Overall survival (OS) and progression-free survival (PFS) were analyzed using the Kaplan-Meier method. Cox regression analysis was performed evaluating potential prognostic factors for OS and PFS. Each factor was evaluated in univariable (UVA) and multivariable analysis (MVA). RESULTS: A total of 208 evaluable patients treated with ICIs were identified, including 122 (59%) without BoM (BoM-) and 86 (41%) with bone metastases (BoM+). After a median follow-up of 22.3 months, BoM+ patients showed shorter OS (median 3.9 vs 7.8 months, HR 1.59 [95%CI, 1.15-2.20], P = .005) and shorter PFS (median 2.0 vs 2.6 months, HR 1.76 [95%CI, 1.31-2.37], P < .001). Probability of being alive was 62% vs 40% after 6 months, 38% vs 23% after 1 year and 24% vs 13% after 2 years, in BoM- and BoM+ respectively. Within each Bellmunt score, OS and PFS of BoM+ patients were shorter. Both presence of BoM and higher Bellmunt risk score were significantly associated with shorter OS and PFS in UVA and MVA. CONCLUSION: Patients treated with single-agent ICIs for BoM+ mUC have a dismal prognosis compared to BoM-. Further research is needed to understand the mechanism behind these outcomes.
Authors: Husam A Alqaisi; Carlos Stecca; Zachary W Veitch; Jamila Riromar; Jeenan Kaiser; Nazanin Fallah-Rad; Di Maria Jiang; Scott North; Sunil Samnani; Nimira Alimohamed; Srikala S Sridhar Journal: Ther Adv Med Oncol Date: 2022-05-01 Impact factor: 5.485