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Pembrolizumab and Atezolizumab have been approved for first-line treatment of advanced urothelial carcinoma (aUC) whose tumors are not suitable for cisplatin-based chemotherapy and whose tumors express PD-L1
.
However, the efficacy of these immunotherapy drugs compared with standard chemotherapy is still in the open and has been the focus of attention
immunity
The aim of this study was to compare single-agent immuno-oncology (IO) compounds with platinum-based chemotherapy as first-line therapy in advanced urothelial carcinoma
.
We systematically searched PubMed, EMBASE, Web of Science and Scopus databases from January 2016 to May 2021 for phase 3 clinical trials comparing IO and chemotherapy
.
Algorithms for obtaining survival data from published Kaplan-Meier curves were used to reconstruct overall survival (OS) data
Overall survival with IO vs chemotherapy in total patients
After screening, 2068 subjects from 3 Phase 3 trials comparing IO versus chemotherapy were finally included
.
Overall, survival was comparable among patients treated with IO (n=1013 [49%]) or chemotherapy (n=1055 [51%]), with a 24-month limited mean difference in survival events (ΔRMST) of only - 0.
Overall survival with IO vs chemotherapy in cisplatin-intolerant patients
Patients who could not be treated with cisplatin also had comparable overall survival with IO (n=509 [49%]) or other chemotherapeutic agents (n=530 [51%]), with a 24-month ΔRMST of only 0.
Overall survival with IO vs chemotherapy in cisplatin-intolerant patients with high PD-L1 expression
There was also no significant difference in overall survival among patients with high PD-L1 expression who were ineligible for cisplatin and treated with IO (n=226 [50%]) or chemotherapy (n=226 [50%]), with ΔRMST at 24 months was 1.
Taken together, the results of this study show that the survival benefits of immunosuppressive or chemotherapy as first-line treatment in patients with advanced urothelial carcinoma are equally divided regardless of whether they tolerate cisplatin and whether PD-L1 expression levels are high or low
Regardless of cisplatin tolerance and PD-L1 expression levels, the survival benefit of immunosuppressive or chemotherapy as first-line therapy in patients with advanced urothelial carcinoma was equally divided regardless of cisplatin tolerance and PD-L1 expression levels.
Original source:
Martini Alberto,Raggi Daniele,Fallara Giuseppe et al.
Immunotherapy versus chemotherapy as first-line treatment for advanced urothelial cancer: A systematic review and meta- analysis
