Optimal Timing of Switching from Platinum-based Chemotherapy to Pembrolizumab for Advanced Urothelial Carcinoma Based on Real-world Data: A Multi-institutional Retrospective Study

• Published in: Anticancer research Vol. 42; no. 3; pp. 1571 - 1577
• Main Authors: Furubayashi, Nobuki, Morokuma, Futoshi, Tomoda, Toshihisa, Hori, Yoshifumi, Negishi, Takahito, Miura, Akihiro, Komori, Hiroki, Kuroiwa, Kentaro, Nakamura, Motonobu
• Format: Journal Article
• Language: English
• Published: Greece International Institute of Anticancer Research 01-03-2022
• Subjects: Aged; Aged, 80 and over; Antibodies, Monoclonal, Humanized - administration & dosage; Antibodies, Monoclonal, Humanized - adverse effects; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Carcinoma - drug therapy; Carcinoma - mortality; Carcinoma - pathology; Chemotherapy; Drug Substitution - adverse effects; Drug Substitution - mortality; Female; Humans; Immune Checkpoint Inhibitors - administration & dosage; Immune Checkpoint Inhibitors - adverse effects; Japan; Male; Middle Aged; Patients; Pembrolizumab; Platinum; Regression models; Retrospective Studies; Risk Assessment; Risk Factors; Switching; Time Factors; Treatment Outcome; Urinary Bladder Neoplasms - drug therapy; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - pathology; Urological cancer; Urothelial carcinoma; Japan; Advanced urothelial carcinoma; platinum-based chemotherapy pembrolizumab; real-world clinical practice
• DOI: 10.21873/anticanres.15631
• EISSN: 1791-7530
• ISSN: 0250-7005

The optimal timing of switching from platinum-based chemotherapy to pembrolizumab in patients with advanced urothelial carcinoma (UC) remains unclear.
Thirty-four patients who received pembrolizumab as second-line treatment after first-line platinum-based chemotherapy were retrospectively evaluated.
According to overall survival (OS) from pembrolizumab, there was a significant difference between ≤4 and >4 prior chemotherapy cycles (7.0 and 25.5 months, p=0.034), but not between ≤6 and >6 cycles (11.3 and 6.6 months, p=0.658). According to the Cox proportional hazards regression model, the number of chemotherapy cycles was not correlated with better OS in pembrolizumab-treated patients. According to the OS from the first-line treatment, there was a significant difference between ≤4 and >4 prior chemotherapy cycles (17.3 and 37.1 months, p<0.001), but not between ≤6 and >6 cycles (18.6 and 27.3 months, p=0.276).
The optimal timing of switching from platinum-base chemotherapy to pembrolizumab in advanced UC is around six cycles.