UNI-MB - logo
UMNIK - logo
 
E-viri
Celotno besedilo
Recenzirano Odprti dostop
  • Bellmunt, Joaquim; de Wit, Ronald; Fradet, Yves; Climent, Miguel A; Petrylak, Daniel P; Lee, Jae-Lyun; Fong, Lawrence; Necchi, Andrea; Sternberg, Cora N; O'Donnell, Peter H; Powles, Thomas; Plimack, Elizabeth R; Bajorin, Dean F; Balar, Arjun V; Castellano, Daniel; Choueiri, Toni K; Culine, Stephane; Gerritsen, Winald; Gurney, Howard; Quinn, David I; Vuky, Jacqueline; Vogelzang, Nicholas J; Cristescu, Razvan; Lunceford, Jared; Saadatpour, Assieh; Loboda, Andrey; Ma, Junshui; Rajasagi, Mohini; Godwin, James Luke; Homet Moreno, Blanca; Grivas, Petros

    Clinical cancer research, 05/2022, Letnik: 28, Številka: 10
    Journal Article

    In an exploratory analysis, we investigated the association between programmed death ligand 1 (PD-L1), tumor mutational burden (TMB), T-cell-inflamed gene expression profile (TcellinfGEP), and stromal signature with outcomes of pembrolizumab in urothelial carcinoma (UC). Patients with advanced UC received first-line pembrolizumab 200 mg every 3 weeks in the single-arm phase II KEYNOTE-052 trial (NCT02335424) and salvage pembrolizumab 200 mg every 3 weeks or chemotherapy (paclitaxel/docetaxel/vinflunine) in the randomized phase III KEYNOTE-045 trial (NCT02256436). The association of each biomarker (continuous variable) with objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) was evaluated using logistic regression (ORR) and Cox PH (PFS, OS), adjusted for ECOG PS; nominal P values were calculated without multiplicity adjustment (one-sided, pembrolizumab; two-sided, chemotherapy). Significance was prespecified at α = 0.05. In KEYNOTE-052, PD-L1, TMB, and TcellinfGEP were significantly associated with improved outcomes; stromal signature was significantly associated with worse outcomes. In KEYNOTE-045, although findings for TMB and TcellinfGEP with pembrolizumab were consistent with those of KEYNOTE-052, PD-L1 was not significantly associated with improved outcomes, nor was stromal signature associated with worse outcomes with pembrolizumab; chemotherapy was not associated with outcomes in a consistent manner for any of the biomarkers. Hazard ratio (HR) estimates at prespecified cutoffs showed an advantage for pembrolizumab versus chemotherapy regardless of PD-L1 or TMB, with a trend toward lower HRs in the combined positive score ≥10 and the TMB ≥175 mutation/exome subgroup. For TcellinfGEP, PFS and OS HRs were lower in the TcellinfGEP-nonlow subgroup regardless of treatment. Multiple biomarkers characterizing the tumor microenvironment may help predict response to pembrolizumab monotherapy in UC, and potential clinical utility of these biomarkers may be context-dependent.