Nobutaka Nishimura1, Makito Miyake2, Takuto Shimizu1, Toshihiko Matsubara3, Tatsuki Miyamoto4, Keichi Sakamoto1, Atsushi Yamada4, Yoshihiro Matsumoto4, Motokiyo Yoshikawa5, Kazuki Ichikawa6, Chihiro Omori7, Fumisato Maesaka8, Yuki Oda9, Keisuke Kiba10, Atsushi Tomioka11, Yukinari Hosokawa12, Masahiro Tanaka13, Takeshi Otani14, Kiyohide Fujimoto1. 1. Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan. 2. Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan. makitomiyake@yahoo.co.jp. 3. Department of Urology, Gyoumeikan Hospital, Osaka, Japan. 4. Department of Urology, Hoshigaoka Medical Center, Hirakata, Osaka, Japan. 5. Department of Urology, Yamato Takada Municipal Hospital, Yamatotakada, Nara, Japan. 6. Department of Urology, Kouseikai Takai Hospital, Tenri, Nara, Japan. 7. Department of Urology, Nara Prefecture General Medical Center, Nara, Japan. 8. Department of Urology, Nara City Hospital, Nara, Japan. 9. Department of Urology, Nara Prefecture Seiwa Medical Center, Ikoma, Nara, Japan. 10. Department of Urology, Kindai University Nara Hospital, Ikoma, Nara, Japan. 11. Department of Urology, Saiseikai Chuwa Hospital, Sakurai, Nara, Japan. 12. Department of Urology, Tane General Hospital, Osaka, Japan. 13. Department of Urology, Gokeikai Osaka Kaisei Hospital, Osaka, Japan. 14. Department of Urology, Matsusaka Chuo General Hospital, Matsusaka, Mie, Japan.
Abstract
BACKGROUND: First-line pembrolizumab is available for recurrent disease within 12 months after the receipt of platinum-based perioperative chemotherapy. However, the benefit of first-line pembrolizumab is unclear. This study evaluated the oncological outcome of patients treated with pembrolizumab compared with chemotherapy as first-line therapy for early relapsing disease after the receipt of platinum-based perioperative chemotherapy. METHODS: Data from a multicenter study included 454 patients diagnosed with unresectable or metastatic UC from November 2006 to July 2021. We identified patients with early and non-early relapsing disease. Oncological outcomes were evaluated using progression-free survival, overall survival, and survival with disease control. RESULTS: Fifty-three patients with early relapsing disease and 15 patients with non-early relapsing disease were identified. Of 53 patients with early relapsing disease, 26 (49.1%) were treated with pembrolizumab and 27 (50.9%) were treated with chemotherapy as first-line therapy. Fifteen patients with non-early relapsing disease were treated with chemotherapy. Early relapsing disease was associated with shorter progression-free survival and overall survival than non-early relapsing disease. Pembrolizumab was associated with longer progression-free survival and survival with disease control than chemotherapy in patients with early relapsing disease. There was no significant difference in overall survival between pembrolizumab and chemotherapy, but overall survival plateau with a long tail was observed in pembrolizumab. CONCLUSIONS: First-line pembrolizumab in earlier clinical settings for highly malignant tumors might improve the prognosis of patients with early relapsing disease after the receipt of platinum-based perioperative chemotherapy.
BACKGROUND: First-line pembrolizumab is available for recurrent disease within 12 months after the receipt of platinum-based perioperative chemotherapy. However, the benefit of first-line pembrolizumab is unclear. This study evaluated the oncological outcome of patients treated with pembrolizumab compared with chemotherapy as first-line therapy for early relapsing disease after the receipt of platinum-based perioperative chemotherapy. METHODS: Data from a multicenter study included 454 patients diagnosed with unresectable or metastatic UC from November 2006 to July 2021. We identified patients with early and non-early relapsing disease. Oncological outcomes were evaluated using progression-free survival, overall survival, and survival with disease control. RESULTS: Fifty-three patients with early relapsing disease and 15 patients with non-early relapsing disease were identified. Of 53 patients with early relapsing disease, 26 (49.1%) were treated with pembrolizumab and 27 (50.9%) were treated with chemotherapy as first-line therapy. Fifteen patients with non-early relapsing disease were treated with chemotherapy. Early relapsing disease was associated with shorter progression-free survival and overall survival than non-early relapsing disease. Pembrolizumab was associated with longer progression-free survival and survival with disease control than chemotherapy in patients with early relapsing disease. There was no significant difference in overall survival between pembrolizumab and chemotherapy, but overall survival plateau with a long tail was observed in pembrolizumab. CONCLUSIONS: First-line pembrolizumab in earlier clinical settings for highly malignant tumors might improve the prognosis of patients with early relapsing disease after the receipt of platinum-based perioperative chemotherapy.