First-line pembrolizumab for patients with early relapsing urothelial carcinoma after perioperative chemotherapy: a retrospective analysis of bladder cancer and upper urinary tract cancer

• DOI: 10.1007/s10147-022-02230-9
• Publication Date: 2022-08-27T09:07:01Z
• Authors: Nobutaka Nishimura; Makito Miyake; Takuto Shimizu; Toshihiko Matsubara; Tatsuki Miyamoto; Keichi Sakamoto; Atsushi Yamada; Yoshihiro Matsumoto; Motokiyo Yoshikawa; Kazuki Ichikawa; Chihiro Omori; Fumisato Maesaka; Yuki Oda; Keisuke Kiba; Atsushi Tomioka; Yukinari Hosokawa; Masahiro Tanaka; Takeshi Otani; Kiyohide Fujimoto
• Keywords: Carcinoma, Transitional Cell; Urologic Neoplasms; 03 medical and health sciences; 0302 clinical medicine; Urinary Bladder Neoplasms; Antineoplastic Combined Chemotherapy Protocols; Humans; Neoplasm Recurrence, Local; Retrospective Studies; 3. Good health

First-line pembrolizumab is available for recurrent disease within 12 months after the receipt of platinum-based perioperative chemotherapy. However, the benefit of first-line pembrolizumab is unclear. This study evaluated the oncological outcome of patients treated with pembrolizumab compared with chemotherapy as first-line therapy for early relapsing disease after the receipt of platinum-based perioperative chemotherapy.Data from a multicenter study included 454 patients diagnosed with unresectable or metastatic UC from November 2006 to July 2021. We identified patients with early and non-early relapsing disease. Oncological outcomes were evaluated using progression-free survival, overall survival, and survival with disease control.Fifty-three patients with early relapsing disease and 15 patients with non-early relapsing disease were identified. Of 53 patients with early relapsing disease, 26 (49.1%) were treated with pembrolizumab and 27 (50.9%) were treated with chemotherapy as first-line therapy. Fifteen patients with non-early relapsing disease were treated with chemotherapy. Early relapsing disease was associated with shorter progression-free survival and overall survival than non-early relapsing disease. Pembrolizumab was associated with longer progression-free survival and survival with disease control than chemotherapy in patients with early relapsing disease. There was no significant difference in overall survival between pembrolizumab and chemotherapy, but overall survival plateau with a long tail was observed in pembrolizumab.First-line pembrolizumab in earlier clinical settings for highly malignant tumors might improve the prognosis of patients with early relapsing disease after the receipt of platinum-based perioperative chemotherapy.