Immune Checkpoint Blockade Therapies Efficacy and Toxicity in Patients With Impaired Renal Function in Metastatic Bladder Cancer

Clin Genitourin Cancer. 2024 Dec;22(6):102228. doi: 10.1016/j.clgc.2024.102228. Epub 2024 Oct 4.

Abstract

Background: In this study, we reported the real-life results of data from impaired renal patients with urothelial carcinoma who were treated with ICTs.

Methods: The patients were categorized into 3 different groups GFR ≥60mL/min (normal), 60mL/min-30mL/min (low), and less than 30 mL/min (very low) based on GFR. The primary endpoints were the overall response rate (ORR), overall survival (OS), duration of response with ICT, and safety. Median follow-up and OS were estimated by using the Kaplan-Meier method.

Results: One hundred-five (60.3%) of patients were GFR normal, 26.4% were GFR low with 30mL/min-60mL/min, and 13.2% were very low group. ORR for GFR normal, low and very low groups were 36% (n = 38), 26% (n = 12) and %31 (7); P = .2, respectively. The median duration of response for GFR normal, low and very low groups were 47.2 months (95% CI, 24.5-51.4), 33.1 months (95% CI, 26.9-47), and 23.5 months (95% CI, 12.2-43.7); P = .01, respectively. The Median OS rate for GFR normal, low and very low groups were 11.9 (7.2-16.5) months, 4.7 (1.8-7.7) and 6.8 (1.1-13.6) months, P = .015, respectively. In addition, GFR <60 ml/min HR = 1.6; 95% CI 1.12-1.80; P = .02, maintained a significant association with OS in multivariate analysis.

Conclusions: Long-term follow-up of real-world data confirms that the overall survival rate and durable response rate with ICT were higher in patients with GFR >60mL/min. On the other hand, we demonstrated that ICT was effective and a durable response seen in a group of patients with renal inpairement who did not have an effective systemic treatment option.

Keywords: Immune checkpoint blockade therapies; Long Term follow up; Outcomes; Renal failure; Urothelial carcinoma.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carcinoma, Transitional Cell / drug therapy
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate*
  • Humans
  • Immune Checkpoint Inhibitors* / adverse effects
  • Immune Checkpoint Inhibitors* / therapeutic use
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Renal Insufficiency
  • Retrospective Studies
  • Treatment Outcome
  • Urinary Bladder Neoplasms* / drug therapy
  • Urinary Bladder Neoplasms* / pathology

Substances

  • Immune Checkpoint Inhibitors