文章：

局部晚期或转移性尿路上皮癌一线治疗方案的头对头比较：化疗是否仍具一席之地？

A Head-to-Head Comparison of the First-Line Treatments for Locally Advanced or Metastatic Urothelial Cancer: Is There Still a Role for Chemotherapy?

原文发布日期：29 June 2024

DOI: 10.3390/cancers16132400

类型: Article

开放获取: 是

英文摘要：

Background: Patients with locally advanced/metastatic urothelial cancer have been conventionally treated with platinum-based chemotherapy. Recently, numerous new treatments have been proposed to improve overall survival (OS) and reduce adverse effects, but no direct head-to-head comparisons among these agents are available. Methods: The treatments evaluated in our analyses included (a) monotherapy with immune checkpoint inhibitors (ICI); (b) combinations of an ICI with chemotherapy; and (c) combinations of an ICI with other drugs. Using OS as the endpoint, a series of indirect comparisons were performed to rank the most effective regimens against both chemotherapy and each other. Our analysis was based on the application of an artificial intelligence software program (IPDfromKM method) that reconstructs individual patient data from the information reported in the graphs of Kaplan–Meier curves. Results: A total of five studies published in six articles were included. In our main analysis, nivolumab plus chemotherapy showed better OS compared to chemotherapy (HR = 0.70, 95% CI: 0.59–0.82), while durvalumab plus tremelimumab showed no OS benefit (HR = 0.95, 95% CI 0.82–1.11). More interestingly, enfortumab vedotin plus pembrolizumab significantly prolonged OS compared to both chemotherapy alone (HR = 0.53, 95% CI 0.45–0.63) and nivolumab plus chemotherapy (HR = 0.76, 95% CI 0.60–0.97). Discussion and conclusion: Among new treatments for locally advanced and metastatic urothelial cancer, enfortumab vedotin plus pembrolizumab showed the best efficacy in terms of OS. Our results support the use of this combination as a first-line treatment in this setting.

摘要翻译： 

背景：局部晚期/转移性尿路上皮癌患者传统上采用铂类化疗。近年来，为改善总生存期（OS）并减少不良反应，多种新疗法相继提出，但这些药物之间缺乏直接的头对头比较。方法：我们分析评估的治疗方案包括：（a）免疫检查点抑制剂（ICI）单药治疗；（b）ICI联合化疗；（c）ICI联合其他药物。以OS为终点，通过一系列间接比较对化疗及各方案间的疗效进行排序。我们的分析基于人工智能软件（IPDfromKM方法）的应用，该方法通过卡普兰-迈耶曲线图中的信息重建个体患者数据。结果：共纳入六篇文献报道的五项研究。主要分析显示，与化疗相比，纳武利尤单抗联合化疗具有更优的OS（HR=0.70，95% CI：0.59-0.82），而度伐利尤单抗联合替西木单抗未显示OS获益（HR=0.95，95% CI 0.82-1.11）。更有意义的是，与单纯化疗（HR=0.53，95% CI 0.45-0.63）及纳武利尤单抗联合化疗（HR=0.76，95% CI 0.60-0.97）相比，恩诺单抗联合帕博利珠单抗均显著延长OS。讨论与结论：在局部晚期和转移性尿路上皮癌的新疗法中，恩诺单抗联合帕博利珠单抗在OS方面展现出最佳疗效。我们的研究结果支持将该联合方案作为此类患者的一线治疗方案。

原文链接：

A Head-to-Head Comparison of the First-Line Treatments for Locally Advanced or Metastatic Urothelial Cancer: Is There Still a Role for Chemotherapy?