Survival Benefit for Patients With Metastatic Urothelial Carcinoma Receiving Continuous Maintenance Chemotherapy

Liaw, Chuang-Chi; Liao, Tzu-Yao; Tsui, Ke-Hung; Juan, Yu-Hsiang

doi:10.21873/invivo.11597

Cited by 6 publications

(7 citation statements)

References 42 publications

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“…44 Eleven patients receiving nedaplatin plus pemetrexed as second-line treatment after failure of platinum-based chemotherapy reported an ORR of 63.6% and a median PFS of 7 months. 43 Two studies investigated platinum-based regimens on treatment-naive or treatment-experienced patients, 45,46 with ORR ranging from 60% to 63.5%, 45,46 and OS of 17 months were reported in one study. 46 Two studies investigated cisplatin-based regimens on treatment-naive patients and patients receiving chemotherapy after surgery, reporting ORR of 43.57% to 64.58% and 16.7 months of median OS.…”

Section: Efficacy and Safety Of Available Treatment Optionsmentioning

confidence: 99%

“…43 Two studies investigated platinum-based regimens on treatment-naive or treatment-experienced patients, 45,46 with ORR ranging from 60% to 63.5%, 45,46 and OS of 17 months were reported in one study. 46 Two studies investigated cisplatin-based regimens on treatment-naive patients and patients receiving chemotherapy after surgery, reporting ORR of 43.57% to 64.58% and 16.7 months of median OS. 47,48 Seven studies did not report information on LOT, [29][30][31][49][50][51][52] among which one study found that patients with only lymph node metastasis had better ORR compared to patients with visceral metastasis (64.29% vs. 29.17%, p < 0.05).…”

Section: Efficacy and Safety Of Available Treatment Optionsmentioning

confidence: 99%

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Epidemiology, treatments, and related biomarkers of locally advanced or metastatic urothelial carcinoma in Chinese population: A scoping review

et al. 2023

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ObjectiveBladder cancer is the 13th most common cancer in China with the predominant histologic type being urothelial carcinoma (UC). Locally advanced and metastatic (la/m) UC accounts for 12% of UC and the five‐year survival rate is only 39.4%, imposing a significant disease and economic burden on the patients. The aim of this scoping review is to synthesize existing evidence of epidemiology, the landscape of treatment options and associated efficacy and safety profiles, as well as treatment‐related biomarkers among Chinese la/mUC patients.MethodsA systematic search was conducted on five databases (PubMed, Web of Science, Embase, Wanfang, and CNKI) from January 2011 to March 2022 based on the scoping review criteria in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis Extension for Scoping Reviews.ResultsA total of 6211 records were identified, and further review resulted in 41 relevant studies that met all criteria. Additional searches were conducted on epidemiology and treatment‐related biomarkers of bladder cancer to supplement the evidence. Among 41 studies, 24 reported on platinum‐based chemotherapy, eight on non‐platinum‐based chemotherapy, six on immunotherapy, two on targeted therapy, and one on surgery. Efficacy outcomes were summarized by line of therapy. Treatment‐related biomarkers including PD‐L1, HER2, and FGFR3 alterations were identified, and the alteration rate of FGFR3 of Chinese UC patients was lower than that of the western patients.ConclusionsDespite chemotherapy has been the main treatment choice for decades, appealing new therapeutic strategies including ICIs, targeted therapies and ADCs were applied in clinical practice. Further research on epidemiology and treatment‐related biomarkers of la/mUC patients is needed given only a limited number of studies have been identified thus far. High genomic heterogeneity and complexity of molecular features were observed among la/mUC patients; thus, further studies are required to identify critical drivers and promote potential precise therapies.

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Section: Efficacy and Safety Of Available Treatment Optionsmentioning

confidence: 99%

Section: Efficacy and Safety Of Available Treatment Optionsmentioning

confidence: 99%

Epidemiology, treatments, and related biomarkers of locally advanced or metastatic urothelial carcinoma in Chinese population: A scoping review

et al. 2023

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“…Conventional cisplatin‐based chemotherapies have been the standard of care for fit patients since the 1980s; however, a large proportion (30–62%) of locally advanced or mUC patients are ineligible for first‐line chemotherapy due to poor performance status, impaired renal function, and other comorbidities 5 . Despite the variety of therapeutic options available, the median survival for mUC with the best current practice is a sobering 17 months, 6 highlighting the difficulty in treating this disease and the unmet need for better therapeutics. To date, targeted therapies have not yielded a significant survival benefit in the first‐line setting; however, several phase III trials are currently underway.…”

Section: Introductionmentioning

confidence: 99%

Systemic treatment of advanced and metastatic urothelial cancer: The landscape in Australia

Gurney,

Clay,

Oliveira

et al. 2023

Asia-Pac J Clncl Oncology

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The 5‐year survival rate of metastatic urothelial carcinoma (mUC) is estimated to be as low as 5%. Currently, systemic platinum‐based chemotherapy followed by avelumab maintenance therapy is the only first‐line treatment for mUC that has an overall survival benefit. Cisplatin‐based chemotherapy (usually in combination with gemcitabine) is the preferred treatment but carboplatin is substituted where contraindications to cisplatin exist. Treatment with immune checkpoint inhibitors, antibody‐drug conjugates, and kinase inhibitors has not yet demonstrated superiority to chemotherapy as first‐line therapy and remains investigational in this setting. A recent media release indicates that chemotherapy plus nivolumab gives an OS advantage as first‐line treatment but results of this study have not yet been made public. Pembrolizumab remains an option in those having primary progression on first‐line chemotherapy or within 12 months of neoadjuvant chemotherapy. The antibody‐drug conjugate, enfortumab vedotin has TGA approval for patients whose cancer has progressed following chemotherapy and immunotherapy and has just received a positive Pharmaceutical Benefits Scheme recommendation. The use of molecular screens for somatic genetic mutations, gene amplifications, and protein expression is expanding as drugs that target such abnormalities show promise. However, despite these advances, a substantial proportion of patients with mUC have significant barriers to receiving any treatment, including advancing age, frailty, and comorbidities, and less toxic, effective therapies are needed.

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“…Urothelial carcinoma (UC) accounted for 94.7% of bladder cancer cases in males ( n = 1486) and 92.7% in females ( n = 622) 1 . The 5‐year overall survival (OS) rate for patients with metastatic UC (mUC) was only 18% in Taiwan 2 . The local Urology Management Guideline recommends first‐line (1L) treatment with methotrexate, vinblastine, doxorubicin, and cisplatin or gemcitabine plus cisplatin for patients with locally advanced UC or mUC (la/mUC) 3 .…”

Section: Introductionmentioning

confidence: 99%

A cost‐effectiveness analysis of avelumab plus best supportive care versus best supportive care alone as first‐line maintenance treatment for patients with locally advanced or metastatic urothelial carcinoma in Taiwan

Su,

Xiao,

Lin

et al. 2023

Cancer Reports

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BackgroundPatients with locally advanced or metastatic urothelial carcinoma have limited treatment options and a poor prognosis. The JAVELIN Bladder 100 trial showed that avelumab as first‐line maintenance plus best supportive care significantly prolonged overall survival and progression‐free survival versus best supportive care alone in patients with locally advanced or metastatic urothelial carcinoma that had not progressed with first‐line platinum‐containing chemotherapy.AimsWe assessed whether avelumab plus best supportive care is a cost‐effective treatment option versus best supportive care alone in this patient group in Taiwan.Methods and ResultsA partitioned survival model was used to estimate the costs and effects of avelumab plus best supportive care versus best supportive care alone over a 20‐year time horizon from the perspective of Taiwan's National Health Insurance Administration. Patient‐level data from JAVELIN Bladder 100 on efficacy, safety, utility, and time on treatment were analyzed to provide parameters for the model. Log‐normal and Weibull distributions were used for overall survival and progression‐free survival, respectively. Costs of healthcare resources, drug acquisition, adverse events, and progression were identified through publicly available data sources and clinician interviews. The model estimated total costs, life years, and quality‐adjusted life years. In the modeled base case, avelumab plus best supportive care increased survival versus best supportive care alone by 0.79 life years (2.93 vs. 2.14) and 0.61 quality‐adjusted life years (2.15 vs. 1.54). The incremental cost‐effectiveness ratio for avelumab plus best supportive care versus best supportive care alone was NT$1 827 680. Most (78%) of the probabilistic sensitivity analyses fell below three times the gross domestic product per capita. Scenario analysis indicated that life year and quality‐adjusted life year gains were most sensitive to alternative survival extrapolations for both avelumab plus best supportive care and best supportive care alone.ConclusionAvelumab first‐line maintenance therapy combined with best supportive care was determined as a cost‐effective treatment strategy for patients in Taiwan diagnosed with locally advanced or metastatic urothelial carcinoma that had not progressed with platinum‐containing chemotherapy.

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Survival Benefit for Patients With Metastatic Urothelial Carcinoma Receiving Continuous Maintenance Chemotherapy

Cited by 6 publications

References 42 publications

Epidemiology, treatments, and related biomarkers of locally advanced or metastatic urothelial carcinoma in Chinese population: A scoping review

Epidemiology, treatments, and related biomarkers of locally advanced or metastatic urothelial carcinoma in Chinese population: A scoping review

Systemic treatment of advanced and metastatic urothelial cancer: The landscape in Australia

A cost‐effectiveness analysis of avelumab plus best supportive care versus best supportive care alone as first‐line maintenance treatment for patients with locally advanced or metastatic urothelial carcinoma in Taiwan

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