Advanced upper tract urothelial carcinoma (UTUC) has different molecular and genetic features from the commonest carcinoma of the bladder, suggesting a possible different sensitivity to immune-checkpoint inhibitors (ICI).
A systematic review and meta-analysis of all relevant clinical studies including advanced UTUC patients treated with ICI was conducted according to PRISMA guidelines.
Six prospective trials for a total 2537 patients, including 396 (15.6%) with advanced UTUC, were eligible for the analysis. In UTUC patients, the pooled ORR was 21.2% (95% CI, 12.5%-33.7%); the risk of death was reduced by 24% over the standard platinum-based chemotherapy, but this was not statistically significant (hazard ratio = 0.76; 95% confidence interval, 0.41-1.40; p = 0.37, χ2 = 3.28, p = 0.07; I2 = 70%).
The current evidence does not support a statistically significant effect from ICI over the standard treatment for advanced UTUC patients. Properly performed pre-planned subgroup analyses from randomized clinical trials are eagerly awaited.
Critical reviews in oncology/hematology. 2021 Feb 02 [Epub ahead of print]
Melissa Bersanelli, Sebastiano Buti, Patrizia Giannatempo, Daniele Raggi, Andrea Necchi, Alessandro Leonetti, Giuseppe Luigi Banna, Fausto Petrelli
Medicine and Surgery Department, University of Parma, Parma, Italy; Medical Oncology Unit, University Hospital of Parma, Parma, Italy. Electronic address: ., Medicine and Surgery Department, University of Parma, Parma, Italy; Medical Oncology Unit, University Hospital of Parma, Parma, Italy., Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Portsmouth Hospitals NHS Trust, Portsmouth, UK., Medical Oncology Unit, ASST Bergamo Ovest, Treviglio, BG, Italy.