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Atezolizumab in Resistant Advanced Urothelial Cancer: Prognostic Significance of Pretreatment Factors

By: Jenna Carter, PhD
Posted: Wednesday, August 11, 2021

Not all patients with advanced urothelial cancer have success with platinum-based combination chemotherapy in the first-line setting. Although the more recently developed immune checkpoint inhibitors have shown activity, many do not achieve long-term remission. In a recent article published in ESMO Open Cancer Horizons, researchers evaluated the effects of an immune checkpoint inhibitor following failed platinum-based chemotherapy to assess the impact of certain pretreatment factors on ultimate outcomes. Cora N. Sternberg, MD, of the Englander Institute for Precision Medicine, Weil Cornel Medicine, Meyer Cancer Center, New York, and colleagues reported atezolizumab was equally beneficial regardless of the type of chemotherapy pretreatment.

“[W]e investigate[d] the prognostic value of patient-related characteristics, factors related to previous chemotherapy as well as PD-L1 expression, among patients with advanced urothelial cancer…,” stated Dr. Sternberg and colleagues. “Our results suggest a need for novel prognostic signatures for immunotherapy in advanced urothelial carcinoma.”

A total of 969 patients with locally advanced or metastatic urothelial or non-urothelial carcinoma of the urinary tract were eligible for the single-arm phase III SAUL study. This was a post hoc analysis of patients who received prior cisplatin or carboplatin. Atezolizumab was given at 1,200 mg intravenously every 3 weeks.

Overall findings revealed significant associations between overall survival and the time from last chemotherapy (P < .001), PD-L1 expression (P = .002), and prior perioperative chemotherapy (P = .013). Additionally, they found an association between atezolizumab efficacy and high PD-L1–expressing tumors with tumor-infiltrating immune cells; there was a doubled objective response rate and similar trend in overall survival and progression-free survival. In addition, the number of Bellmunt risk factors seemed to be associated with overall survival (P < .001), with better outcomes with fewer risk factors. According to the investigators, “the type of platinum compound and the number of previous treatment lines were not associated with outcomes.”

Disclosure: For full disclosure of the study authors, visit

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