@article{3102108,
    title = "Immune checkpoint inhibitors in advanced upper and lower tract urothelial carcinoma: a comparison of outcomes",
    author = "Esagian, S.M. and Khaki, A.R. and Diamantopoulos, L.N. and Carril-Ajuria, L. and Castellano, D. and De Kouchkovsky, I. and Park, J.J. and Alva, A. and Bilen, M.A. and Stewart, T.F. and McKay, R.R. and Santos, V.S. and Agarwal, N. and Jain, J. and Zakharia, Y. and Morales-Barrera, R. and Devitt, M.E. and Nelson, A. and Hoimes, C.J. and Shreck, E. and Gartrell, B.A. and Sankin, A. and Tripathi, A. and Zakopoulou, R. and Bamias, A. and Rodriguez-Vida, A. and Drakaki, A. and Liu, S. and Kumar, V. and Lythgoe, M.P. and Pinato, D.J. and Murgic, J. and Fröbe, A. and Joshi, M. and Isaacsson Velho, P. and Hahn, N. and Alonso Buznego, L. and Duran, I. and Moses, M. and Barata, P. and Galsky, M.D. and Sonpavde, G. and Yu, E.Y. and Msaouel, P. and Koshkin, V.S. and Grivas, P.",
    journal = "BJU international (Papier)",
    year = "2021",
    volume = "128",
    number = "2",
    pages = "196-205",
    publisher = "John Wiley and Sons Inc",
    doi = "10.1111/bju.15324",
    keywords = "atezolizumab;  avelumab;  durvalumab;  immune checkpoint inhibitor;  nivolumab;  pembrolizumab;  platinum derivative, advanced cancer;  aged;  Article;  bladder cancer;  cancer immunotherapy;  clinical feature;  clinical outcome;  cohort analysis;  comparative study;  controlled study;  female;  histopathology;  human;  human tissue;  kidney pelvis carcinoma;  major clinical study;  male;  mixed tumor;  outcome assessment;  overall survival;  patient selection;  progression free survival;  retrospective study;  survival time;  transitional cell carcinoma;  treatment response;  ureter cancer;  urethra cancer;  urogenital tract cancer;  cancer staging;  middle aged;  pathology;  transitional cell carcinoma;  treatment outcome;  urinary tract tumor;  very elderly, Aged;  Aged, 80 and over;  Carcinoma, Transitional Cell;  Cohort Studies;  Female;  Humans;  Immune Checkpoint Inhibitors;  Male;  Middle Aged;  Neoplasm Staging;  Retrospective Studies;  Treatment Outcome;  Urologic Neoplasms",
    abstract = "Objectives: To compare clinical outcomes between patients with locally advanced (unresectable) or metastatic urothelial carcinoma (aUC) in the upper and lower urinary tract receiving immune checkpoint inhibitors (ICIs). Patients and Methods: We performed a retrospective cohort study collecting clinicopathological, treatment, and outcome data for patients with aUC receiving ICIs from 2013 to 2020 across 24 institutions. We compared the objective response rate (ORR), overall survival (OS), and progression-free survival (PFS) between patients with upper and lower tract UC (UTUC, LTUC). Uni- and multivariable logistic and Cox regression were used to assess the effect of UTUC on ORR, OS, and PFS. Subgroup analyses were performed stratified based on histology (pure, mixed) and line of treatment (first line, subsequent line). Results: Out of a total of 746 eligible patients, 707, 717, and 738 were included in the ORR, OS, and PFS analyses, respectively. Our results did not contradict the hypothesis that patients with UTUC and LTUC had similar ORRs (24% vs 28%; adjusted odds ratio [aOR] 0.73, 95% confidence interval [CI] 0.43–1.24), OS (median 9.8 vs 9.6 months; adjusted hazard ratio [aHR] 0.93, 95% CI 0.73–1.19), and PFS (median 4.3 vs 4.1 months; aHR 1.01, 95% CI 0.81–1.27). Patients with mixed-histology UTUC had a significantly lower ORR and shorter PFS vs mixed-histology LTUC (aOR 0.20, 95% CI 0.05–0.91 and aHR 1.66, 95% CI 1.06–2.59), respectively). Conclusion: Overall, patients with UTUC and LTUC receiving ICIs have comparable treatment response and outcomes. Subgroup analyses based on histology showed that those with mixed-histology UTUC had a lower ORR and shorter PFS compared to mixed-histology LTUC. Further studies and evaluation of molecular biomarkers can help refine patient selection for immunotherapy. © 2021 The Authors BJU International © 2021 BJU International Published by John Wiley & Sons Ltd"
}