Mp08-19 Impact of Immunotherapy in Metastatic Bladder Cancer Patients With and Without Visceral Metastases: A Meta-Analysis of RCTS

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation I (MP08)1 May 2024MP08-19 IMPACT OF IMMUNOTHERAPY IN METASTATIC BLADDER CANCER PATIENTS WITH AND WITHOUT VISCERAL METASTASES: A META-ANALYSIS OF RCTS Alec Zhu, Stephen P. Rhodes, Parwiz Abrahimi, Xian Wu, Camilo A. Gallo, Manish Kuchakulla, Gal Wald, Mary O. Strasser, Lina Posada, Adithya Balasubramanian, Leo Dreyfuss, and Jonathan E. Shoag Alec ZhuAlec Zhu , Stephen P. RhodesStephen P. Rhodes , Parwiz AbrahimiParwiz Abrahimi , Xian WuXian Wu , Camilo A. GalloCamilo A. Gallo , Manish KuchakullaManish Kuchakulla , Gal WaldGal Wald , Mary O. StrasserMary O. Strasser , Lina PosadaLina Posada , Adithya BalasubramanianAdithya Balasubramanian , Leo DreyfussLeo Dreyfuss , and Jonathan E. ShoagJonathan E. Shoag View All Author Informationhttps://doi.org/10.1097/01.JU.0001008780.87855.57.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Randomized clinical trials (RCTs) comparing immune checkpoint inhibitors (ICI) to chemotherapy in patients with metastatic bladder cancer include varying proportions of patients with visceral and non-visceral metastases. We performed meta-analysis of RCTs evaluating ICI to determine how the proportion of metastatic patients in the study populations affect survival outcomes. METHODS: We identified seven RCTs comparing pembrolizumab (KEYNOTE-361, KEYNOTE-045), avelumab (JAVELIN Bladder 100, Galsky et al.), atezolizumab (IMvigor130, IMvigor211), or durvalumab (DANUBE) vs. chemotherapy in patients with metastatic bladder cancer in the first-line, maintenance, or salvage settings. Using published data, the proportions of patients with visceral vs. non-visceral metastases were extracted, and individual patient data (IPD) was reconstructed from Kaplan-Meier curves using image analysis techniques. IPD was used to calculate the restricted mean survival time differences (RMSTD) between treatment and control arms for overall (OS) and progression-free (PFS) survival at 12- and 24-months. Meta-regression was performed to estimate the change in RMSTD based on the ratio of visceral metastatic to non-visceral metastatic patients. RESULTS: We identified 4,524 patients treated across 7 RCTs for metastatic bladder cancer. The proportion of patients with non-visceral metastases ranged from 4.8% to 45%. RMSTDs between treatment and control arms ranged from -0.5 to 2.4 months for 24-month OS (Table 1). Meta-regression of RMSTDs using a mixed-effects model across the seven RCTs demonstrated decreasing RMSTDs with increasing proportion of patients with visceral metastases (Figure 1). RMSTD significantly decreases per unit increase in the ratio of metastatic to non-metastatic patients for OS (-0.15 95% CI -0.28, -0.01 p=0.04) and PFS (-0.20 95% CI -0.38, -0.02 p=0.04) at 24 months. CONCLUSIONS: The inclusion of greater proportions of non-visceral metastatic bladder cancer patients in RCTs may contribute to increased survival benefit of ICI vs. chemotherapy treatments. Download PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e124 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Alec Zhu More articles by this author Stephen P. Rhodes More articles by this author Parwiz Abrahimi More articles by this author Xian Wu More articles by this author Camilo A. Gallo More articles by this author Manish Kuchakulla More articles by this author Gal Wald More articles by this author Mary O. Strasser More articles by this author Lina Posada More articles by this author Adithya Balasubramanian More articles by this author Leo Dreyfuss More articles by this author Jonathan E. Shoag More articles by this author Expand All Advertisement PDF downloadLoading ...