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. 2024 Mar 3;5(5):490-496.
doi: 10.1002/bco2.335. eCollection 2024 May.

Immune checkpoint inhibitors in high-grade upper tract urothelial carcinoma: Paradigm shift emphasizing organ preservation

Mahmoud Khalil  1   2 , Andrew Fishman  1 , Anna Komorowski  3 , Israel Franco  4 , Michael Grasso 3rd  1   5
Affiliations

Immune checkpoint inhibitors in high-grade upper tract urothelial carcinoma: Paradigm shift emphasizing organ preservation

Mahmoud Khalil et al. BJUI Compass. .

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] BJUI Compass. 2024 Dec 30;5(12):1324-1329. doi: 10.1002/bco2.482. eCollection 2024 Dec. BJUI Compass. 2024. PMID: 39744071 Free PMC article.

Abstract

Objective: The aim was to evaluate the role of immune check point inhibitors (ICIs) in patients with high-grade upper tract urothelial carcinoma (UTUC) who are managed endoscopically when nephroureterectomy (NU) is not feasible, such as in patients who are either not candidates for NU or decline extirpative surgery.

Methods: All patients diagnosed with high-grade UTUC and managed endoscopically between January 1996 and August 2022 were included in the study. Subsequently, patients were categorised based on their use of ICIs into group 1 (patients who did not receive ICIs) and group 2 (patients who received ICIs). Survival outcomes were assessed using Kaplan-Meier analysis, while a multivariable regression model was employed to analyse the impact of clinical characteristics on survival.

Results: A total of 29 patients were enrolled, with 14 in group 1 and 15 in group 2. Both groups exhibited similar demographic and disease characteristics, including multifocality, laterality and initial tumour size. The median follow-up period was 29.2 months. Notably, group 2 demonstrated significantly enhanced overall and metastasis-free survival rates compared to group 1. At 47.8 months, the overall survival rate was 0% (all patients died) in group 1, whereas it was 85.7% in group 2. Similarly, the metastasis-free survival rate was 0% (all patients had metastatic disease) in group 1 at 40.6 months, whereas it reached 78.0% in group 2. The multivariable analysis indicated a correlation between ICI usage and improved survival outcomes, with a hazard ratio of 0.002.

Conclusion: Utilisation of adjuvant ICIs in the setting of endoscopically treated patients with high-grade UTUC is associated with significantly improved survival rates. ICIs should be considered in this patient population, however, more studies with larger sample size are warranted.

Keywords: high grade; immune checkpoint inhibitors; immunotherapy; renal urothelial carcinoma; upper tract urothelial carcinoma; ureteral carcinoma.

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Conflict of interest statement

The authors disclose no potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier survival estimates for overall survival.
FIGURE 2
FIGURE 2
Kaplan–Meier survival estimates for metastasis‐free survival.
See this image and copyright information in PMC

References

    1. Grasso M, Fishman AI, Cohen J, Alexander B. Ureteroscopic and extirpative treatment of upper urinary tract urothelial carcinoma: a 15‐year comprehensive review of 160 consecutive patients. BJU Int. 2012;110(11):1618–1626. 10.1111/j.1464-410X.2012.11066.x - DOI - PubMed
    1. Cutress ML, Stewart GD, Wells‐Cole S, Phipps S, Thomas BG, Tolley DA. Long‐term endoscopic management of upper tract urothelial carcinoma: 20‐year single‐Centre experience. BJU Int. 2012;110(11):1608–1617. 10.1111/j.1464-410X.2012.11169.x - DOI - PubMed
    1. Daneshmand S, Quek ML, Huffman JL. Endoscopic management of upper urinary tract transitional cell carcinoma: long‐term experience. Cancer. 2003;98(1):55–60. 10.1002/cncr.11446 - DOI - PubMed
    1. Birtle A, Johnson M, Chester J, Jones R, Dolling D, Bryan RT, et al. Adjuvant chemotherapy in upper tract urothelial carcinoma (the POUT trial): a phase 3, open‐label, randomised controlled trial. Lancet. 2020;395(10232):1268–1277. 10.1016/S0140-6736(20)30415-3 - DOI - PMC - PubMed
    1. Cutress ML, Stewart GD, Zakikhani P, Phipps S, Thomas BG, Tolley DA. Ureteroscopic and percutaneous management of upper tract urothelial carcinoma (UTUC): systematic review. BJU Int. 2012;110(5):614–628. 10.1111/j.1464-410X.2012.11068.x - DOI - PubMed

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