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Immunotherapy for Urothelial Cancer: Balancing Benefits and Risks

By: Kayci Reyer
Posted: Tuesday, February 23, 2021

According to a retrospective study presented in Frontiers in Oncology, patients with metastatic urothelial carcinoma and end-stage renal disease may derive a modest clinical benefit from receiving immune checkpoint inhibitor treatment. However, Yu-Li Su, MD, of Chang Gung University in Taiwan, and colleagues identified the potential for an increased risk for hematologic toxicity associated with immunotherapy for some of these patients.

The study included 129 patients with metastatic urothelial carcinoma who received immune checkpoint inhibitor treatment at two branches of Chang Gung Memorial Hospital between April 2016 and November 2019. Among those enrolled, 11 patients were identified as having end-stage renal disease. When comparing outcomes for patients with and without end-stage renal disease, the former experienced a superior overall response rate (54.5% vs. 28.8%, P = .09) as well as superior progression-free survival (7.1 months vs. 3.5 months, P = .42) and overall survival (not reached vs. 15.4 months).

The majority of patients with end-stage renal disease (n = 7, 63.6%) experienced an adverse event of at least grade 3. Hematologic toxicity was the most common of such events. Less common adverse events included toxic epidermal necrolysis, tuberculosis reactivation, ascites, and cytokine-release syndrome. Leukocytosis (hazard ratio [HR] = 2.63; 95% confidence interval [CI] = 1.23–5.63; P = .01) and neutrophil-lymphocyte ratio (HR = 2.91; 95% CI = 1.30–6.53; P = .01) were found by a multivariate Cox regression model to be independent prognostic factors.

Disclosure: The study authors reported no conflicts of interest.

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