<p>Organ-Specific Therapeutic Effect of Paclitaxel and Carboplatin Chemotherapy After Platinum-Based Chemotherapy and Pembrolizumab for Metastatic Urothelial Carcinoma</p>

Abstract

Background: To evaluate the organ-specific therapeutic effect of paclitaxel and carboplatin (TC) chemotherapy in patients who failed platinum-based chemotherapy and pembrolizumab for metastatic urothelial carcinoma (UC). Patients and Methods: We retrospectively reviewed the data of patients with metastatic UC who had received TC chemotherapy after the failure of platinum-based chemotherapy and pembrolizumab. The RECIST 1.1 criteria were used to assess the objective response to pembrolizumab and TC chemotherapy at tumor sites. Results: We analyzed 8 patients (male, n=5; female, n=3; median age, 65 years old). All patients except one had visceral metastasis. The median overall survival for TC was 10.9 months (95% confidence interval, 1.0-12.7 months), and the objective response rate was 25.0% (partial response [PR]: 2 cases). The metastatic organs were the lymph nodes in 5 cases (number of tumor sites: 8), lung in 4 cases (number of tumor sites: 12), liver in 3 cases (number of tumor sites: 14), bone in 3 cases (number of tumor sites: 12), and primary lesion in 3 cases (number of tumor sites: 3). There were no cases of a complete response or progressive disease in any metastatic organs due to TC chemotherapy. A PR was seen in 2 cases of lymph node metastasis (40.0%), 2 cases of lung metastasis (50.0%), and 2 cases of liver metastasis (66.7%). All 3 cases of bone metastasis showed stable disease, as did all 3 cases of primary lesion. Improvement in the therapeutic effect of TC chemotherapy compared with pembrolizumab was observed in 2 cases (40.0%) of lymph node metastasis, 2 cases (50.0%) of lung metastasis, and 1 case (33.3%) of liver metastasis. Conclusion: Lymph node, lung, and liver metastases may respond to TC chemotherapy, even if exacerbated with pembrolizumab after platinum-based chemotherapy in metastatic UC.

Enfortumab vedotin versus platinum rechallenge in post‐platinum, post‐pembrolizumab advanced urothelial carcinoma: A multicenter propensity score‐matched study

“…Platinum rechallenge has been reported to be a potentially effective treatment for advanced UC 13–20 . For example, Gravis et al.…”

Organ-Specific Tumor Response to Pembrolizumab in Advanced Urothelial Carcinoma After Platinum-Based Chemotherapy

“…All metastases that measured ≥5 mm in the long axis (lymph node [LN] metastases ≥10 mm in the short axis) on computed tomography were defined as measurable lesions and were measured before and during pembrolizumab treatment. 12 , 16 The objective response rate (ORR) and disease control rate (DCR) were determined (based on Response Evaluation Criteria in Solid Tumors [RECIST], version 1.1) in up to five lesions in total and up to two lesions per organ for target lesions. Furthermore, for the organ-specific response rate (OSRR) and organ-specific disease control rate (OSDCR), the tumor burden was defined as the sum of the long axis for all non-LN metastases or the short axis of all LN metastases that were measured and evaluated according to RECIST 1.1.…”

“…For each metastatic organ, the best response was classified as a complete response (CR) (disappearance or reduction to <10 mm in the short axis for all LN metastases), a partial response (PR) (>30% reduction), stable disease (SD) (neither a CR, PR, nor progressive disease [PD]), or PD (>20% growth). 12 , 16 …”

Prognostic and Predictive Factors in Advanced Urothelial Carcinoma Treated with Immune Checkpoint Inhibitors: A Review of the Current Evidence

“…The survival benefit of immunotherapy in both untreated and pretreated patients with mUC has been observed regardless of all of those clinical factors, confirming their prognostic but not predictive value, in many retrospective analyses [ 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 ] and subgroup and post-hoc analyses of prospective randomised trials [ 71 , 72 ].…”