Evolution of front-line immunotherapy for metastatic urothelial cancer

• Published in: The lancet oncology Vol. 25; no. 1; pp. 2 - 3
• Main Authors: Siefker-Radtke, Arlene O, Desai, Monica
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.01.2024; Elsevier Limited
• Subjects: Bladder cancer; Cancer therapies; Chemotherapy; Cisplatin; Gemcitabine; Hematology, Oncology, and Palliative Medicine; Immune checkpoint inhibitors; Immunotherapy; Medical prognosis; Metastases; Metastasis; Monoclonal antibodies; Platinum; Response rates; Survival; Targeted cancer therapy; Urothelial cancer
• ISSN: 1470-2045; 1474-5488; 1474-5488
• DOI: 10.1016/S1470-2045(23)00633-2

Despite the previously reported improvement in progression-free survival with first-line combination of atezolizumab plus platinum-based chemotherapy versus placebo plus platinum-based chemotherapy in the primary analysis (stratified hazard ratio [HR] 0·82 [95% CI 0·70–0·96]; one-sided p=0·007),3 this did not translate into an improvement in overall survival (median overall survival was 16·1 months [95% CI 14·2–18·8; 336 death] in group A vs 13·4 months [12·0–15·3] in group C; stratified HR 0·85 [95% CI 0·73–1·00]; one-sided p=0·023).1 The investigators designed the trial with the aim of answering many questions regarding front-line immune checkpoint inhibition. Recent results from CheckMate901 reported an improvement in overall survival with nivolumab combined with gemcitabine and cisplatin versus gemcitabine and cisplatin alone (median overall survival 21·7 months [95% CI 18·6–26·4] vs 18·9 months [14·7–22·4]) with an objective response rate of 175 (57·6%) of 304 patients with nivolumab combination therapy versus 131 (43·1%) of 304 patients with gemcitabine and cisplatin alone, and complete response rates of 21·7% and 11·8% respectively.4 The duration of complete response appeared quite promising, with a median duration of 37·1 months with combination therapy and 13·2 months with gemcitabine plus cisplatin. If the survival remains this high, sequencing of treatment might also be relevant since 25% of patients received subsequent platinum-based therapy. [...]it might be too early to consider retirement of platinum-based chemotherapy.