Immune checkpoint inhibitors in high‐grade upper tract urothelial carcinoma: Paradigm shift emphasizing organ preservation
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 dec...
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Wiley
2024-05-01
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| Series: | BJUI Compass |
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| Online Access: | https://doi.org/10.1002/bco2.335 |
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| author | Mahmoud Khalil Andrew Fishman Anna Komorowski Israel Franco Michael Grasso III |
| author_facet | Mahmoud Khalil Andrew Fishman Anna Komorowski Israel Franco Michael Grasso III |
| author_sort | Mahmoud Khalil |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-be68000a24ad4f37bc956f8b82e52e1c |
| institution | DOAJ |
| issn | 2688-4526 |
| language | English |
| publishDate | 2024-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | BJUI Compass |
| spelling | doaj-art-be68000a24ad4f37bc956f8b82e52e1c2025-08-20T02:40:24ZengWileyBJUI Compass2688-45262024-05-015560461010.1002/bco2.335Immune checkpoint inhibitors in high‐grade upper tract urothelial carcinoma: Paradigm shift emphasizing organ preservationMahmoud Khalil0Andrew Fishman1Anna Komorowski2Israel Franco3Michael Grasso III4Department of Urology Phelps Hospital, Northwell Health Sleepy Hollow New York USADepartment of Urology Phelps Hospital, Northwell Health Sleepy Hollow New York USADepartment of Hematology and Medical Oncology Phelps Hospital, Northwell Health Sleepy Hollow New York USADepartment of Urology Yale School of Medicine New Haven Connecticut USADepartment of Urology Phelps Hospital, Northwell Health Sleepy Hollow New York USAAbstract 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.https://doi.org/10.1002/bco2.335high gradeimmune checkpoint inhibitorsimmunotherapyrenal urothelial carcinomaupper tract urothelial carcinomaureteral carcinoma |
| spellingShingle | Mahmoud Khalil Andrew Fishman Anna Komorowski Israel Franco Michael Grasso III Immune checkpoint inhibitors in high‐grade upper tract urothelial carcinoma: Paradigm shift emphasizing organ preservation BJUI Compass high grade immune checkpoint inhibitors immunotherapy renal urothelial carcinoma upper tract urothelial carcinoma ureteral carcinoma |
| title | Immune checkpoint inhibitors in high‐grade upper tract urothelial carcinoma: Paradigm shift emphasizing organ preservation |
| title_full | Immune checkpoint inhibitors in high‐grade upper tract urothelial carcinoma: Paradigm shift emphasizing organ preservation |
| title_fullStr | Immune checkpoint inhibitors in high‐grade upper tract urothelial carcinoma: Paradigm shift emphasizing organ preservation |
| title_full_unstemmed | Immune checkpoint inhibitors in high‐grade upper tract urothelial carcinoma: Paradigm shift emphasizing organ preservation |
| title_short | Immune checkpoint inhibitors in high‐grade upper tract urothelial carcinoma: Paradigm shift emphasizing organ preservation |
| title_sort | immune checkpoint inhibitors in high grade upper tract urothelial carcinoma paradigm shift emphasizing organ preservation |
| topic | high grade immune checkpoint inhibitors immunotherapy renal urothelial carcinoma upper tract urothelial carcinoma ureteral carcinoma |
| url | https://doi.org/10.1002/bco2.335 |
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