Outcome of patients with advanced upper tract urothelial carcinoma treated with immune checkpoint inhibitors: A systematic review and meta-analysis. (March 2021)

• Record Type: Journal Article
• Authors: Bersanelli, Melissa; Buti, Sebastiano; Giannatempo, Patrizia; Raggi, Daniele; Necchi, Andrea; Leonetti, Alessandro; Banna, Giuseppe Luigi; Petrelli, Fausto
• Is Part Of: Critical reviews in oncology/hematology. Volume 159(2021)
• Publication Date: 2021-03
• Subjects: UTUC -- Upper tract urothelial cancer -- Immune checkpoint inhibitors -- Immunogenicity -- Renal pelvis -- Urothelial cancer; Oncology -- Periodicals; Hematology -- Periodicals; 616.994
• DOI: 10.1016/j.critrevonc.2021.103241
• Languages: English
• ISSNs: 1040-8428

Abstract

Graphical abstract: Highlights: Upper tract urothelial cancer (UTUC) represent a separate entity from bladder cancer. We described the outcome of UTUC patients receiving immune checkpoint inhibitors (ICI) in clinical trials. Of 2537 patients, 396 affected by UTUC were treated with ICIs (15.6 %). The pooled ORR for 232 patients was 21.2 % (95 % CI, 12.5 %–33.7 %). ICIs decreased the risk of death over chemotherapy by 24 % (HR = 0.76; 95 %CI, 0.41–1.40; p = 0.37). Abstract: Background: Advanced upper tract urothelial carcinoma (UTUC) has different molecular and genetic features from the commonest carcinoma of the bladder, suggesting a possible different sensitivity to immune-checkpoint inhibitors (ICI). Methods: A systematic review and meta-analysis of all relevant clinical studies including advanced UTUC patients treated with ICI was conducted according to PRISMA guidelines. Results: Six prospective trials for a total 2537 patients, including 396 (15.6 %) with advanced UTUC, were eligible for the analysis. In UTUC patients, the pooled ORR was 21.2 % (95 % CI, 12.5 %–33.7 %); the risk of death was reduced by 24 % over the standard platinum-based chemotherapy, but this was not statistically significant (hazard ratio = 0.76; 95 % confidence interval, 0.41–1.40; p = 0.37, χ2 = 3.28, p = 0.07; I2 = 70 %). Conclusions: The current evidence does not support a statistically significant effect from ICI over the standard treatment for advanced UTUC patients. Properly performed pre-planned subgroup analyses from randomized clinical trials are eagerly awaited.