Impact of histological variants on outcomes in patients with urothelial carcinoma treated with pembrolizumab: a propensity score matching analysis. (6th July 2021)

• Record Type: Journal Article
• Authors: Kobayashi, Mizuki; Narita, Shintaro; Matsui, Yoshiyuki; Kanda, Souhei; Hidaka, Yu; Abe, Hiroyasu; Tsuzuki, Toyonori; Ito, Katsuhiro; Kojima, Takahiro; Kato, Minoru; Hatakeyama, Shingo; Matsushita, Yuto; Naito, Sei; Shiga, Masanobu; Miyake, Makito; Muro, Yusuke; Nakanishi, Shotaro; Kato, Yoichiro; Shibuya, Tadamasa; Hayashi, Tetsutaro; Yasumoto, Hiroaki; Yoshida, Takashi; Uemura, Motohide; Taoka, Rikiya; Kamiyama, Manabu; Morita, Satoshi; Habuchi, Tomonori; Ogawa, Osamu; Nishiyama, Hiroyuki; Kitamura, Hiroshi; Kobayashi, Takashi;
• Other Names: Hikami Kensuke investigator.; Yamada Takeshi investigator.; Ogawa Kosuke investigator.; Nakamura Kenji investigator.; Sassa Naoto investigator.; Yokomizo Akira investigator.; Abe Takashige investigator.; Tsuchihashi Kazunari investigator.; Tatarano Shuichi investigator.; Inokuchi Junichi investigator.; Tomida Ryotaro investigator.; Fujiwara Maki investigator.; Takahashi Atsushi investigator.; Matsumoto Kazumasa investigator.; Shimizu Kosuke investigator.; Araki Hiromasa investigator.; Kurahashi Ryoma investigator.; Ozaki Yu investigator.; Tashiro Yu investigator.; Uegaki Masayuki investigator.; Maruyama Satoru investigator.; Mukai Shoichiro investigator.; Tsutsumi Masakazu investigator.; Miki Jun investigator.; Okuno Tomoya investigator.; Yoshio Yuko investigator.; Matsumoto Hiroaki investigator.; Shimazui Toru investigator.; Segawa Takehiko investigator.; Karashima Takashi investigator.; Masui Kimihiko investigator.; Fukuta Fumimasa investigator.; Tashiro Kojiro investigator.; Imai Kazuto investigator.; Suekane Shigetaka investigator.; Nagasawa Seiji investigator.; Higashi Shin investigator.; Fukui Tomohiro investigator.;
• Is Part Of: BJU international. Volume 130:Number 2(2022)
• Page Start: 226
• Page End: 234
• Publication Date: 2021-07-06
• Subjects: urothelial cancer chemo‐resistant -- histological variant -- sarcomatoid -- immune checkpoint inhibitor -- pembrolizumab; Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.15510
• Languages: English
• ISSNs: 1464-4096

Abstract

Abstract : Objectives: To assess the impact of histological variants on survival and response to treatment with pembrolizumab in patients with chemo‐resistant urothelial carcinoma (UC). Patients and Methods: The medical records of 755 patients with advanced UC who received pembrolizumab were reviewed retrospectively. Patients were classified into pure UC (PUC) and each variant. Best overall response (BOR) and overall survival (OS) were compared between the groups using a propensity score matching (PSM). Results: Overall, 147 (19.5%) patients harboured any histological variant UC (VUC). After PSM, there were no significant differences in the objective response rate (ORR, 24.5% vs 17.3%, P = 0.098) or disease control rate (DCR, 36.7% vs 30.2%, P = 0.195) when comparing patients with any VUC and PUC. Furthermore, any VUC, as compared with PUC, was associated with a similar risk of death (hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.68–1.20; P = 0.482). Squamous VUC, which was the most frequent variant in the cohort, had a comparable ORR, DCR and OS as compared with PUC or non‐squamous VUC. The patients with sarcomatoid VUC ( n = 19) had significantly better ORR (36.8%, P = 0.031), DCR (52.6%, P = 0.032), and OS (HR 0.37, 95% CI 0.15–0.90; P = 0.023) compared to patients with PUC. Conclusions: The presence of variant histology did not seem to affect BOR or OS after pembrolizumab administration in patients with chemo‐resistant UC. The patients with sarcomatoid VUC achieved favourable responses and survival rates compared to PUC.