Pre-first-line chemotherapy risk stratification for overall survival in advanced urothelial carcinoma in sequential...

Area of Science:

• Oncology
• Urothelial Carcinoma Research
• Cancer Treatment Strategies

Background:

• Advanced urothelial carcinoma (UC) treatment has evolved with sequential therapy (ST) incorporating immune checkpoint inhibitors (ICIs).
• Identifying patients at risk for poor overall survival (OS) is essential for optimizing treatment pathways.
• Understanding pre-treatment factors influencing treatment outcomes in UC is critical for personalized medicine.

Purpose of the Study:

• To identify pre-treatment risk factors for overall survival (OS) in advanced urothelial carcinoma (UC) patients receiving first-line (1L) chemotherapy.
• To evaluate the impact of these risk factors on the ability of patients to receive subsequent immune checkpoint inhibitor (ICI) therapy within a sequential therapy (ST) context.

Main Methods:

• A multicenter retrospective study including 314 advanced or metastatic UC patients treated between 2017-2022.
• Kaplan-Meier analysis, log-rank tests, and multivariate Cox regression models were employed to assess OS.
• Subgroup analysis was performed to evaluate the proportion of patients unable to receive ICI therapy based on identified risk factors.

Main Results:

• ECOG-PS ≥1, no primary tumor resection, CRP ≥3 mg/dL, and non-cisplatin regimens were associated with poorer OS.
• Patients with 3 or 4 risk factors had a significantly higher risk of not receiving subsequent ST (P < 0.001).
• For patients able to receive ST, risk factors for OS included no primary site resection, neutrophil-to-lymphocyte ratio ≥3, and liver metastasis.

Conclusions:

• Pre-treatment risk factors significantly impact overall survival in advanced UC patients undergoing first-line chemotherapy.
• These risk factors also influence the feasibility of proceeding to subsequent immune checkpoint inhibitor therapy in the sequential therapy era.
• Identifying high-risk patients early can guide treatment decisions and potentially improve outcomes in advanced UC.