학술논문
Real-world sequential treatment patterns and clinical outcomes among patients with advanced urothelial carcinoma in Japan.
Document Type
Academic Journal
Author
Kita Y; Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan.; Otsuka H; Department of Urology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.; Ito K; Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan.; Hara T; Department of Urology, Kobe University, Kobe, Japan.; Shimura S; Department of Urology, Kitasato University, Tokyo, Japan.; Kawahara T; Department of Urology, University of Tsukuba, Tsukuba, Japan.; Kato M; Department of Urology, Osaka Metropolitan University, Osaka, Japan.; Kanamaru S; Department of Urology, Kobe City Nishi-Kobe Medical Center, Kobe, Japan.; Inoue K; Department of Urology, Kurashiki Central Hospital, Kurashiki, Japan.; Ito H; Department of Urology, Yokohama City University, Yokohama, Japan.; Igarashi A; Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan.; Sazuka T; Department of Urology, Chiba University, Chiba, Japan.; Takamatsu D; Department of Urology, Kyushu University, Fukuoka, Japan.; Hashimoto K; Department of Urology, Sapporo Medical University, Sapporo, Japan.; Abe T; Department of Urology, Hokkaido University, Sapporo, Japan.; Naito S; Department of Urology, Yamagata University, Tsuruoka, Japan.; Matsui Y; Department of Urology, National Cancer Center Hospital, Tokyo, Japan.; Nishiyama H; Department of Urology, Yamagata University, Tsuruoka, Japan.; Kitamura H; Department of Urology, University of Toyama, Toyama, Japan.; Kobayashi T; Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Source
Publisher: Blackwell Science Asia Country of Publication: Australia NLM ID: 9440237 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1442-2042 (Electronic) Linking ISSN: 09198172 NLM ISO Abbreviation: Int J Urol Subsets: MEDLINE
Subject
Language
English
Abstract
Objectives: Immune checkpoint inhibitors and enfortumab vedotin have opened new avenues for sequential treatment strategies for locally advanced/metastatic urothelial carcinoma (la/mUC). In the pre-enfortumab vedotin era, many patients could not receive third-line treatment owing to rapid disease progression and poor general status. This study aimed to analyze real-world sequential treatment practices for la/mUC in Japan, with a focus on patients who do not receive third-line treatment.
Methods: We analyzed data for 1023 la/mUC patients diagnosed between January 2020 and December 2021 at 54 institutions from a Japanese nationwide cohort.
Results: At the median follow-up of 28.5 months, the median overall survival from first-line initiation for 905 patients who received systemic anticancer treatment was 19.1 months. Among them, 81% and 32% received second- and third-line treatment. Notably, 52% had their treatment terminated before the opportunity for third-line treatment. Multivariate logistic regression analysis revealed that low performance status (≥1), elevated neutrophil-to-lymphocyte ratio (≥3), and low body mass index (<21 kg/m2 ) at the start of first-line treatment were independent risk factors for not proceeding to third-line treatment (p = 0.0024, 0.0069, and 0.0058, respectively). In this cohort, 33% had one of these factors, 36% had two, and 15% had all three.
Conclusions: This study highlights the high frequency of factors associated with poor tolerance to anticancer treatment in la/mUC patients. The findings suggest the need to establish optimal sequential treatment strategies, maximizing efficacy within time and tolerance constraints, while concurrently providing strong supportive care, considering immunological and nutritional aspects.
(© 2024 The Authors. International Journal of Urology published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Urological Association.)
Methods: We analyzed data for 1023 la/mUC patients diagnosed between January 2020 and December 2021 at 54 institutions from a Japanese nationwide cohort.
Results: At the median follow-up of 28.5 months, the median overall survival from first-line initiation for 905 patients who received systemic anticancer treatment was 19.1 months. Among them, 81% and 32% received second- and third-line treatment. Notably, 52% had their treatment terminated before the opportunity for third-line treatment. Multivariate logistic regression analysis revealed that low performance status (≥1), elevated neutrophil-to-lymphocyte ratio (≥3), and low body mass index (<21 kg/m
Conclusions: This study highlights the high frequency of factors associated with poor tolerance to anticancer treatment in la/mUC patients. The findings suggest the need to establish optimal sequential treatment strategies, maximizing efficacy within time and tolerance constraints, while concurrently providing strong supportive care, considering immunological and nutritional aspects.
(© 2024 The Authors. International Journal of Urology published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Urological Association.)