PD-1抗体与化疗无交叉耐药
  • 免疫检查点抑制剂(ICIs)治疗晚期泌尿上皮癌(MUC)有效,与化疗一起成为标准治疗;
  • 28例晚期MUC患者,分为二组,A组患者一线ICIs,进展后化疗,B组患者一线含铂方案化疗、二线ICIs治疗进展后化疗;
  • A组的最佳缓解率64%,B组的最佳缓解率21%,B组患者化疗结束时疾病进展率43%;
  • MUC患者中,ICIs与化疗之间无交叉耐药,为达最大疗效,治疗的顺序非常重要。
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European Urology [IF:17.947]

Response Rate to Chemotherapy After Immune Checkpoint Inhibition in Metastatic Urothelial Cancer

晚期泌尿上皮癌,免疫检查点抑制剂治疗耐药后进行化疗的缓解率

10.1016/j.eururo.2017.08.022

2017-09-13, Article

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Immune checkpoint inhibitors (ICIs) are active in metastatic urothelial carcinoma (MUC). They have joined chemotherapy (CT) as a standard of care. Here, we investigate the activity of CT after progression on ICIs. Two cohorts of sequential patients with MUC were described (n=28). Cohort A received first-line ICIs followed by CT after progression. Cohort B received CT after failure of first-line platinum-based CT followed by ICIs. Response rate (RR) to CT was assessed using Response Evaluation Criteria in Solid Tumors (RECIST v1.1) by a designated radiologist. Best RR for cohort A was 64%. Two patients experienced clinical progression and died before the first radiographic assessment. RR for cohort B was 21%, which was significantly lower than that for cohort A. Progression of disease occurred in 43% of cohort B patients by the end of CT. These data suggest a lack of cross resistance between CT and ICIs in MUC. Therefore, the sequencing of these drugs is likely to be important to maximise outcomes. This is particularly true after first-line ICIs as subsequent CT has significant activity.
PATIENT SUMMARY: In this report, we studied the effect of chemotherapy in metastatic bladder cancer, which relapsed after immune checkpoint inhibitors. We found that the activity of chemotherapy was maintained despite previous exposure to immune therapy. This underlines the importance of sequencing these agents to maximise outcomes.

First Authors:
Bernadett Szabados

Correspondence Authors:
Thomas Powles

All Authors:
Bernadett Szabados,Nick van Dijk,Yen Zhi Tang,Michiel S van der Heijden,Akhila Wimalasingham,Alfonso Gomez de Liano,Simon Chowdhury,Simon Hughes,Sarah Rudman,Mark Linch,Thomas Powles

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