Mp77-07 Clinical Impact of C-Reactive Protein Flare Response in Patients With Advanced Urothelial Carcinoma Who Received Pembrolizumab

You have accessJournal of UrologyBladder Cancer: Invasive VI (MP77)1 May 2024MP77-07 CLINICAL IMPACT OF C-REACTIVE PROTEIN FLARE RESPONSE IN PATIENTS WITH ADVANCED UROTHELIAL CARCINOMA WHO RECEIVED PEMBROLIZUMAB Ikko Tomisaki, Yujiro Nagata, Akinori Minato, Kenichi Harada, and Naohiro Fujimoto Ikko TomisakiIkko Tomisaki , Yujiro NagataYujiro Nagata , Akinori MinatoAkinori Minato , Kenichi HaradaKenichi Harada , and Naohiro FujimotoNaohiro Fujimoto View All Author Informationhttps://doi.org/10.1097/01.JU.0001009404.49693.12.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: C-reactive protein (CRP) has been reported as one of the biomarkers in patients who received immune checkpoint inhibitor (ICI) for various malignancies including urothelial carcinoma (UC). Additionally, kinetics of CRP during the treatment has been reported as useful for predicting the efficacy. However, there are extremely limited data on temporary elevated CRP levels followed by decreasing below baseline (CRP flare response) after administration of ICI. The aim of this study was to clarify the clinical significance of CRP flare response after administering pembrolizumab in patients with advanced UC. METHODS: We retrospectively reviewed patients with advanced UC who consecutively received pembrolizumab as second-line or later therapy between March 2018 and January 2023 at one academic center and six general hospitals. Patients were categorized into 3 groups according to early CRP kinetics: flare-responder (CRP levels had increased to more than double from baseline within 1 month after pembrolizumab administration (CRP flare) and decreasing to below-baseline levels within 3 months); responder (CRP levels decreased ≥30% from baseline within 3 months without CRP flare); non-responder (the remaining patients). Tumor responses, overall survival (OS), progression-free survival (PFS), and adverse events (AEs) were compared among the groups. RESULTS: A total of 97 eligible patients, 15, 25, and 57 patients were classified into flare-responder, responder, and non-responder group, respectively. Objective response rates of flare-responder and responder were higher than that of non-responder group (43%, 52% vs. 17%). Median follow-up was 7.8 months. Progression and death were observed in 83 and 70 patients, respectively. Median OS was 19.8, 15.2, and 7.8 months in the flare-responder, responder, and non-responder group, respectively (p=0.03). Furthermore, Median PFS was 8.1, 6.3, and 2.7 months in the flare-responder, responder, and non-responder group, respectively (p=0.006). In multivariate analysis, CRP-flare response was a significant favorable predictive factor associated with OS. The patients who developed any grade AEs were 33, 40, 21% in the flare-responder, responder, and non-responder group, respectively (p=0.16). Additionally, there were no significant differences in occurrence of severe AEs (≥Grade 3). CONCLUSIONS: CRP flare response was observed in 15% of patients with advanced UC who received pembrolizumab and favorable oncological outcomes were observed in these patients. CRP-flare might be a promising predictive and prognostic marker in patients with advanced UC who underwent pembrolizumab therapy. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1254 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Ikko Tomisaki More articles by this author Yujiro Nagata More articles by this author Akinori Minato More articles by this author Kenichi Harada More articles by this author Naohiro Fujimoto More articles by this author Expand All Advertisement PDF downloadLoading ...