Experience of using atezolizumab in 1st line therapy of metastatic urothelial cancer
https://doi.org/10.17650/1726-9776-2019-15-3-113-119
Abstract
The article presents 2 clinical examples of using a PD-L1 inhibitor atezolizumab in treatment of urothelial cancer. In the 1st clinical case of bladder cancer, due to concomitant pathology any platinum-containing therapy was impossible. After 9 months of treatment with atezolizumab target lesions decreased by 55 %, and the patient’s condition improved significantly: pain intensity decreased, dysuria frequency decreased, appetite became normal. In the 2 nd clinical case of urothelial cancer, complete response to therapy was achieved after 10 months of treatment. Pain intensity decreased significantly, dysuria was cured. Both patients continue atezolizumab immunotherapy without any adverse events. Therefore, use of up-to-date oncoimmunological medications has entered clinical practice and allows to achieve good therapeutic effect with high treatment safety.
About the Authors
R. A. GafanovRussian Federation
86 Profsoyuznaya St., Moscow 117997
A. G. Dzidzaria
Russian Federation
86 Profsoyuznaya St., Moscow 117997
V. A. Rebrikova
Russian Federation
86 Profsoyuznaya St., Moscow 117997
References
1. Choueiri T.K., Ross R.W., Jacobus S. et al. Double-blind, randomized trial of docetaxel plus vandetanib versus docetaxel plus placebo in platinum-pretreated metastatic urothelial cancer. J Clin Oncol 2012;30(5):507–12. DOI: 10.1200/JCO.2011.37.7002.
2. Bellmunt J., Théodore C., Demkov T. et al. Phase III trial of vinflunine plus best supportive care compared with best supportive care alone after a platinum-containing regimen in patients with advanced transitional cell carcinoma of the urothelial tract. J Clin Oncol 2009;27(27):4454–61. DOI: 10.1200/JCO.2008.20.5534.
3. von der Maase H.J., Hansen S.W., Roberts J.T. et al. Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. Clin Oncol 2000;18(17):3068–77. DOI: 10.1200/JCO.2000.18.17.3068.
4. Galsky M.D., Hahn N.M., Rosenberg J. et al. Treatment of patients with metastatic urothelial cancer "unfit" for Cisplatin-based chemotherapy. J Clin Oncol 2011;29(17):2432–8. DOI: 10.1200/JCO.2011.34.8433.
5. De Santi M., Bellmunt J., Mead G. et al Randomized phase II/III trial assessing gemcitabine/carboplatin and methotrexate/ carboplatin/vinblastine in patients with advanced urothelial cancer who are unfit for cisplatin-based chemotherapy: EORTC study 30986. J Clin Oncol 2012;30(2):191–9. DOI: 10.1200/JCO.2011.37.3571.
6. Herr H.W., Morales A. History of bacillus Calmette–Guerin and bladder cancer: an immunotherapy success story. J Urol 2008;179(1):53–6. DOI: 10.1016/j.juro.2007.08.122.
7. Chen D.S., Mellman I. Oncology meets immunology: the cancer-immunity cycle. Immunity 2013;39(1):1–10. DOI: 10.1016/j.immuni.2013.07.012.
8. Chen D.S., Irving B.A., Hodi F.S. Molecular pathways: next-generation immunotherapyinhibiting programmed death-ligand 1 and programmed death-1. Clin Cancer Res 2012;18(24):6580–7. DOI: 10.1158/10780432.CCR-12-1362.
9. Li X., Shao C., Shi Y., Han W. Lessons learned from the blockade of immune checkpoints in cancer immunotherapy. J Hematol Oncol 2018;11(1):31. DOI: 10.1186/s13045-018-0578-4.
10. Seidel J.A., Otsuka A., Kabashima K. AntiPD-1 and anti-CTLA-4 therapies in cancer: mechanisms of action, efficacy, and limitations. Front Oncol 2018;8:86. DOI: 10.3389/fonc.2018.00086.
11. Data from the State Register of Medicines (07.25.2019).(In Russ.).
12. Brahmer J.R., Drake C.G., Wollner I. et al. Phase I study of single-agent anti-programmed death-1 (MDX-1106) in refractory solid tumors: safety, clinical activity, pharmacodynamics, and immunologic correlates. J Clin Oncol 2010;28(19):3167–75. DOI: 10.1200/JCO.2009.26.7609.
13. Powles T., Eder J.P., Fine G.D. et al. MPDL3280A (anti-PD-L1) treatment leads to clinical activity in metastatic bladder cancer. Nature 2014;515(7528):558–62. DOI: 10.1038/nature13904.
14. Herbst R.S., Soria J.C., Kowanetz M. et al. Predictive correlates of response to the antiPD-L1 antibody MPDL3280A in cancer patients. Nature 2014;515(7528):563–7. DOI: 10.1038/nature14011.
15. Schmid P., Hegde P., Zou W. et al. Association of PD-L2 expression in human tumors with atezolizumab activity. J Clin Oncol 2016(abstr 11506).
16. Wang Y., Zhou S., Yang F. et al. Treatmentrelated adverse events of PD-1 and PD-L1 inhibitors in clinical trials a systematic review and meta-analysis. JAMA Oncol 2019;5(7): 1008–19. DOI: 10.1001/jamaoncol.2019.0393.
17. Balar A.V. Atezolizumab (atezo) in first-line cisplatin-ineligible or platinum-treated locally advanced or metastatic urothelial cancer (mUC): Long-term efficacy from phase 2 study IMvigor210. ASCO 2018(abstract 4523):poster 349.
18. Merseburger A.S. Primary results from SAUL, a prospective multinational singlearm study of atezolizumab for locally advanced or metastatic urothelial or non-urothelial carcinoma of the urinary tract. EAU 2019. Plenary Session – Plenary Session 5 BN: Breaking news session.
Review
For citations:
Gafanov R.A., Dzidzaria A.G., Rebrikova V.A. Experience of using atezolizumab in 1st line therapy of metastatic urothelial cancer. Cancer Urology. 2019;15(3):113-119. (In Russ.) https://doi.org/10.17650/1726-9776-2019-15-3-113-119