Clinical genitourinary cancer最新文献

{"title":"Attrition Rates in Metastatic Renal Cell Carcinoma (mRCC) Following First Line Immunotherapy-Based Treatment: Results From the International mRCC Database Consortium (IMDC)","authors":"Audreylie Lemelin ,&nbsp;Martin Zarba ,&nbsp;Kosuke Takemura ,&nbsp;J. Connor Wells ,&nbsp;Razane El Hajj Chehade ,&nbsp;Frede Donskov ,&nbsp;Camillo Porta ,&nbsp;Guillermo De Velasco ,&nbsp;Ian D. Davis ,&nbsp;Lori A. Wood ,&nbsp;Sumanta K. Pal ,&nbsp;Aaron R. Hansen ,&nbsp;Ben Tran ,&nbsp;Georg A. Bjarnason ,&nbsp;Haoran Li ,&nbsp;Ravindran Kanesvaran ,&nbsp;Thomas Powles ,&nbsp;Rana R. McKay ,&nbsp;Toni K. Choueiri ,&nbsp;Daniel Y.C. Heng","doi":"10.1016/j.clgc.2025.102484","DOIUrl":"10.1016/j.clgc.2025.102484","url":null,"abstract":"<div><h3>Background</h3><div>Attrition rates for patients with mRCC are not well characterized in the era of immunoncology (IO)-based combinations. This study aims to quantify real-world attrition rates by line of therapy, analyze associated clinical predictors, and describe treatment sequencing across multiple international centers.</div></div><div><h3>Methods</h3><div>IMDC data for patients with mRCC who received first line Nivolumab + Ipilimumab (IO-IO) or IO- Vascular Endothelial Growth Factor receptor targeted therapy (VEGFR TT) (IO-VE) were included. Clinical and pathologic characteristics and outcomes were extracted. Chi-square tests were used to compare categorical variables between patients who received second line and those who did not. A logistic regression model was used to assess predictors of second line therapy initiation.</div></div><div><h3>Results</h3><div>A total of 1411 patients were identified, of whom 995 patients were treated with first line IO-IO and 434 with IO-VE. Of them, 935 (704 first line IO-IO and 231 first line IO-VE) stopped first line and were suitable for second line therapy. Reasons for stopping first line included progressive disease (PD) in 41.1%, toxicity in 24.4%, death in 3.9%, complete response in 1.5% and other in 28.3%. Among second line suitable patients, 544 (58.2%) started any second line whereas 391 (41.8%) did not. Patients who stopped first line for PD were more likely to initiate second line than those who stopped for other reasons (57.9% vs. 17.6%, <em>P</em> &lt; .00001). Patients who received second line were more likely to have clear-cell histology (77.2% vs. 66.8%, <em>P</em> = .04), without sarcomatoid features (57.2 vs. 44.8%, <em>P</em> = .02), a Karnofsky performance score (KPS) of 80 or higher (80.1 vs. 73.9%, <em>P</em> = .01), and bone metastases (39.0 vs. 28.1%, <em>P</em> = .0009). (Table 2). After adjusting for IMDC criteria, only age and reason for stopping first line remained significant predictors of receiving second line therapy. Among 353 patients who stopped second line, 199 (56.4%, overall 21.3%) started third line therapy. Of the 139 patients who stopped third line, 80 (57.6%, overall 8.6%) started fourth line therapy.</div></div><div><h3>Conclusions</h3><div>In this real-world analysis, we found that just over half of suitable patients received the subsequent line of therapy post first line. We were able to identify age and reason for stopping first line as predictors of second line therapy initiation.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102484"},"PeriodicalIF":2.7,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Fat and Muscle Mass With Overall Survival in Patients With Metastatic Prostate Cancer Treated With Enzalutamide, Abiraterone, and Docetaxel","authors":"İhsan Solmaz ,&nbsp;Halil Kömek ,&nbsp;Fethullah Kayan ,&nbsp;Canan Can ,&nbsp;İhsan Kaplan ,&nbsp;Rıdvan Kiliç ,&nbsp;Yunus Güzel ,&nbsp;Mehmet Serdar Yildirim ,&nbsp;Ömer Faruk Alakuş ,&nbsp;Bilgin Bahadır Başgöz ,&nbsp;Mehmet Özel ,&nbsp;Eşref Araç","doi":"10.1016/j.clgc.2025.102482","DOIUrl":"10.1016/j.clgc.2025.102482","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the association between fat and muscle mass parameters and overall survival in patients with castration-resistant metastatic prostate cancer (mCRPC) receiving chemotherapy or androgen deprivation therapy.</div></div><div><h3>Materials and Methods</h3><div>This retrospective study included mCRPC patients treated with docetaxel, abiraterone, or enzalutamide between January 01, 2017 and December 31, 2022. CT images at the L3 vertebral level were used to measure the cross-sectional areas of psoas muscle (PM), skeletal muscle (SM), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT). These values were normalized by height (cm²/m²) to calculate indices (PMI, SMI, VATI, SATI). Mean hounsfield unit (HU) values of right and left PM were used to assess myosteatosis. Changes in body composition before and after treatment (eg, ΔVATI, ΔSATI) were also calculated. Survival analysis was performed using (ROC) receiver operating curves and Kaplan-Meier tests.</div></div><div><h3>Results</h3><div>Univariate Cox regression showed significant associations between mortality and age, treatment type, right PM HU (pre and post-treatment), left PM HU (post-treatment), post-treatment VATI, ΔSATI, ΔVATI, and baseline PMI (<em>P</em> &lt; .05 for all). In multivariate analysis, post-treatment right PM HU and VATI were independent prognostic factors (<em>P</em> = .02 and <em>P</em> &lt; .001, respectively).</div></div><div><h3>Conclusion</h3><div>Fat mass, sarcopenia, and myosteatosis—especially post-treatment VATI and right PM attenuation—were associated with survival in mCRPC. Fat loss and increased myosteatosis may negatively affect prognosis, highlighting the importance of body composition monitoring during treatment.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102482"},"PeriodicalIF":2.7,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-Immunotherapy Arm Allocations in Phase 3 Genitourinary Cancer Trials with Immunotherapy","authors":"Abby L. Grier ,&nbsp;Albert Jang ,&nbsp;Jeffrey Y. Zhong ,&nbsp;Hamsa L.S. Kumar ,&nbsp;Tanya Jindal ,&nbsp;Adam Calaway ,&nbsp;Angela Y. Jia ,&nbsp;Pingfu Fu ,&nbsp;Laura Bukavina ,&nbsp;Rashed Ghandour ,&nbsp;Jonathan E. Shoag ,&nbsp;Randy Vince ,&nbsp;Santosh Rao ,&nbsp;Iris Sheng ,&nbsp;Prateek Mendiratta ,&nbsp;Jason R. Brown ,&nbsp;Shilpa Gupta ,&nbsp;Jorge A. Garcia ,&nbsp;Pedro C. Barata","doi":"10.1016/j.clgc.2025.102483","DOIUrl":"10.1016/j.clgc.2025.102483","url":null,"abstract":"<div><h3>Introduction</h3><div>Immune checkpoint inhibitors are a standard of care in managing locally advanced and metastatic genitourinary cancers.</div></div><div><h3>Methods</h3><div>We evaluated the utilization of immune checkpoint inhibitors as subsequent therapy in patients enrolled to 11 registrational phase III cancer immunotherapy trials that demonstrated an overall survival benefit.</div></div><div><h3>Results</h3><div>For renal cell carcinoma (<em>n</em> = 5135 patients, 2014-2019), approximately 60% of control-arm patients received subsequent therapy upon progression, with 70% of those receiving an immune checkpoint inhibitor. For urothelial carcinoma (<em>n</em> = 3445 patients, 2015-2022), 54% of control-arm patients received subsequent therapy upon progression, with 69% of those receiving an immune checkpoint inhibitor.</div></div><div><h3>Conclusion</h3><div>Patients randomized to the control arm of these trials did not consistently receive immune checkpoint inhibitors upon progression. Further research is needed to understand how access to subsequent therapies impacts overall survival, and to identify factors associated with inconsistent provision of subsequent therapies.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102483"},"PeriodicalIF":2.7,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indeterminate Surgical Margins (Rx) in Renal Cell Carcinoma Surgery: Rates, Predictive Factors, and Impact on Overall Survival","authors":"Dejan K. Filipas ,&nbsp;José I. Nolazco ,&nbsp;Benjamin V. Stone ,&nbsp;Michael Rink ,&nbsp;Edoardo Beatrici ,&nbsp;Muhieddine Labban ,&nbsp;Stuart R. Lipsitz ,&nbsp;Margit Fisch ,&nbsp;Toni K. Choueiri ,&nbsp;Alexander P. Cole ,&nbsp;Quoc-Dien Trinh ,&nbsp;Steve L. Chang","doi":"10.1016/j.clgc.2025.102481","DOIUrl":"10.1016/j.clgc.2025.102481","url":null,"abstract":"<div><h3>Background and Objective</h3><div>Indeterminate pathological margins (Rx) in renal cell carcinoma (RCC) surgery may affect overall survival. This study aims to evaluate Rx rates, identify predictive factors, and assess their impact on overall survival compared to negative margins (R0).</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 473,152 RCC patients from the National Cancer Database (2004-2020). Patients underwent partial or radical nephrectomy. The primary outcome was Rx at final pathology. Multivariable logistic regression and Cox proportional hazard regression were employed to identify predictors and assess survival impact.</div></div><div><h3>Key Findings and Limitations</h3><div>Rx was observed in 0.62% of cases. Partial nephrectomy, laparoscopic approach, and major vein involvement were associated with increased odds of Rx. Rx was linked to worse overall survival (adjusted Hazard Ratio 1.38; 95% CI, 1.22-1.57; <em>P</em> &lt; .01). Limitations include selection bias and data quality variations.</div></div><div><h3>Conclusions and Clinical Implications</h3><div>Our study indicates that Rx should not be considered equivalent to R0 resection status, as it is associated with worse overall survival in RCC. These findings may aid in the postoperative risk assessment of RCC patients and guide clinical decision-making.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102481"},"PeriodicalIF":2.7,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cabozantinib Beyond VEGFR Inhibition: Reprogramming the IO-Refractory Microenvironment in Metastatic RCC","authors":"Asim Armagan Aydin ,&nbsp;Erkan Kayikcioglu","doi":"10.1016/j.clgc.2025.102485","DOIUrl":"10.1016/j.clgc.2025.102485","url":null,"abstract":"","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102485"},"PeriodicalIF":2.7,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary Malignancy After EBRT: A Closer Look at Absolute Risk and Follow-Up","authors":"Ahmet Necati Sanli ,&nbsp;Deniz Esin Tekcan Sanli","doi":"10.1016/j.clgc.2025.102479","DOIUrl":"10.1016/j.clgc.2025.102479","url":null,"abstract":"","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102479"},"PeriodicalIF":2.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urothelial Carcinoma In Situ: Advances in Diagnosis and Management","authors":"Gabriele Ricciardi ,&nbsp;Pietro Tralongo ,&nbsp;Francesco Pierconti ,&nbsp;Valeria Zuccalà ,&nbsp;Vincenzo Fiorentino ,&nbsp;Ludovica Pepe ,&nbsp;Mariagiovanna Ballato ,&nbsp;Antonio Ieni ,&nbsp;Marta Rossanese ,&nbsp;Vincenzo Ficarra ,&nbsp;Guido Fadda ,&nbsp;Maurizio Martini","doi":"10.1016/j.clgc.2025.102478","DOIUrl":"10.1016/j.clgc.2025.102478","url":null,"abstract":"<div><div>Carcinoma in situ (CIS) of the urinary tract is an aggressive, flat, high-grade form of non–muscle-invasive urothelial carcinoma, associated with a high risk of recurrence and progression. Its diagnosis remains challenging due to the absence of specific symptoms and the frequent overlap with benign inflammatory lesions. Although intravesical <em>Bacillus</em> Calmette-Guérin (BCG) remains the standard of care, many patients experience relapse or develop BCG-unresponsive disease, for which effective alternatives are urgently needed. Recent advances in diagnostic techniques, such as narrow band imaging and photodynamic diagnosis, have improved detection accuracy, while novel therapeutic strategies, such as immune checkpoint inhibitors, thermo-chemotherapy, intravescical gene therapy (nadofaragene firadenovec), IL-15 superagonists (eg, ALT-803), and oncolytic viral therapies (eg, CG0070), are expanding the treatment landscape. Furthermore, emerging molecular and immune-related biomarkers may help predict response to therapy and guide personalized management. This review summarizes current evidence on the biology, diagnosis, and treatment of CIS, highlighting key challenges and future directions in the effort to improve patient outcomes and reduce the need for radical cystectomy.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102478"},"PeriodicalIF":2.7,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Treatment Outcomes in Patients With Ga68-PSMA-PET Positive Metastatic Hormone-Sensitive Prostate Cancer With or Without Conventional Imaging Correlates","authors":"Wadih Issa ,&nbsp;Maureen Aliru ,&nbsp;Song Zhang ,&nbsp;Damla Gunenc ,&nbsp;Changchuan Jiang ,&nbsp;Qian Qin ,&nbsp;Suzanne Cole ,&nbsp;Waddah Arafat ,&nbsp;Jue Wang ,&nbsp;Daniel Yang ,&nbsp;Neil Desai ,&nbsp;Aurelie Garant ,&nbsp;Raquibul Hannan ,&nbsp;Orhan K. Oz ,&nbsp;Solomon Woldu ,&nbsp;Yair Lotan ,&nbsp;Claus Roehrborn ,&nbsp;Kevin Courtney ,&nbsp;Andrew Z. Wang ,&nbsp;Tian Zhang","doi":"10.1016/j.clgc.2025.102476","DOIUrl":"10.1016/j.clgc.2025.102476","url":null,"abstract":"<div><h3>Background</h3><div>Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging is highly sensitive, enabling detection of disease not visualized on conventional imaging, and leading to a new disease state: PSMA-avid/CT-negative metastatic prostate cancer. The optimal management and treatment outcomes for this group remain poorly defined. We investigated whether treatment intensification with androgen receptor signaling inhibitors (ARSI) provides additional benefit for these patients.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of patients with metastatic hormone-sensitive prostate cancer (mHSPC) diagnosed via standard-of-care PSMA PET/CT imaging (Ga68 gozetotide/PSMA-11) at our institution. Patients were stratified based on whether PSMA-avid lesions (SUVmax &gt; 2.5) had correlates on conventional imaging: PSMA (+)/CT (−) versus PSMA (+)/CT (+). We compared prostate-specific antigen progression-free survival (PSA PFS) and castration resistance-free survival (CRFS) between cohorts. OS was not assessed.</div></div><div><h3>Results</h3><div>Among 159 patients, 81 (51%) had PSMA (+)/CT (−) and 78 (49%) had PSMA (+)/CT (+) disease. With a median follow up of 23 months, patients with PSMA (+)/CT (−) mHSPC had significantly longer PSA PFS (hazard ratio [HR] 0.31, <em>P</em> = .01) and CRFS (HR 0.08, <em>P</em> &lt; .001). Within the PSMA (+)/CT (−) cohort, ARSI intensification did not improve CRFS compared to androgen deprivation therapy (ADT) monotherapy (HR 0.32, <em>P</em> = .33).</div></div><div><h3>Conclusions</h3><div>Patients with PSMA (+)/CT (−) mHSPC exhibit a more favorable prognosis with reduced risk of PSA progression and castration resistance compared to those with PSMA (+)/CT (+) disease. However, among patients treated with ADT alone, CRFS was similar across groups, suggesting that the benefit of ARSI intensification in PSMA (+)/CT (−) patients requires prospective validation.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102476"},"PeriodicalIF":2.7,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145836486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trimodality Therapy for Bladder Cancer: A Single Institution Retrospective Analysis of Factors Associated With Outcomes for High-Risk Patients Undergoing Organ-Sparing Therapy","authors":"Monica S. Nair ,&nbsp;Jessica Scarborough ,&nbsp;Chandana A. Reddy ,&nbsp;Anirudh R. Bommireddy ,&nbsp;Erin Brooks ,&nbsp;Nima Almassi ,&nbsp;Christopher J. Weight ,&nbsp;Steven Campbell ,&nbsp;Moshe C. Ornstein ,&nbsp;Amanda Nizam ,&nbsp;Timothy Gilligan ,&nbsp;Christopher Wee ,&nbsp;Shilpa Gupta ,&nbsp;Jacob G. Scott ,&nbsp;Anthony Mastroianni ,&nbsp;Rahul Tendulkar ,&nbsp;Omar Y. Mian","doi":"10.1016/j.clgc.2025.102477","DOIUrl":"10.1016/j.clgc.2025.102477","url":null,"abstract":"<div><h3>Purpose</h3><div>We sought to define patient and disease characteristics associated with outcomes after trimodality therapy (TMT) for high-risk nonmuscle invasive and muscle invasive bladder cancer (MIBC). A retrospective analysis of a large single institution cohort treated with bladder preservation therapy was performed to identify factors associated with survival.</div></div><div><h3>Methods and Materials</h3><div>Patients with high-risk non-MIBC or MIBC who underwent definitive bladder sparing treatment between 2006 and 2022 were included. Variables for analysis included age, sex, Charlson Comorbidity Index (CCI), surgical candidacy, neoadjuvant/induction chemotherapy (NAC), tumor size, presence of hydronephrosis, carcinoma in-situ, and histologic subtype. Kaplan–Meier analysis was done to calculate rates of overall survival (OS) and disease-free survival (DFS), while cumulative incidence analysis was done to calculate rates of cancer specific mortality (CSM) and local recurrence. Cox proportional hazards regression was done to identify factors associated with OS and DFS. Competing risk regression was done to identify factors associated with CSM and local recurrence.</div></div><div><h3>Results</h3><div>226 patients were included in the cohort with a median follow up of 18.9 months (range 0.9-172.3). The median age was 79 years (range 49-98) and 79.2% were male. On univariate Cox proportional hazards regression, younger age, NAC, and cystectomy candidacy were associated with improved OS (<em>P</em> &lt; .0001, HR = 1.05, 95% CI, 1.03-1.08; <em>P</em> = .04, HR = 0.62, 95% CI, 0.39-0.99; <em>P</em> &lt; .0001, HR = 0.42, 95% CI, 0.27-0.65; respectively). On multivariable analysis, only younger age and cystectomy eligibility were associated with improved OS (<em>P</em> = .002, HR = 1.04, 95% CI, 1.02-1.07; <em>P</em> = .006, HR = 0.52, 95% CI, 0.33-0.83; respectively).</div></div><div><h3>Conclusion</h3><div>This study finds cystectomy eligibility to be associated with improved survival and underscores the importance of multi-disciplinary assessment in determining candidacy for organ preserving therapy in MIBC patients.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102477"},"PeriodicalIF":2.7,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Enfortumab Vedotin ± Pembrolizumab Treatment-Based Toxicities and Associations With Survival in Advanced Urothelial Carcinoma","authors":"Martin Kurian ,&nbsp;Ronac Mamtani ,&nbsp;Omar Elghawy ,&nbsp;Vivek Nimgaonkar","doi":"10.1016/j.clgc.2025.102474","DOIUrl":"10.1016/j.clgc.2025.102474","url":null,"abstract":"<div><h3>Introduction</h3><div>Enfortumab vedotin (EV) in combination with pembrolizumab (P) is the first-line treatment for advanced urothelial carcinoma, but real-world toxicity profiles and associations with survival remain an area of active investigation.</div></div><div><h3>Patients and Methods</h3><div>Here, we first perform a single-center (University of Pennsylvania) retrospective study of EV ± P patients to characterize frequency and clinical importance of 5 relevant toxicities (skin reaction, neuropathy, ocular disorder, hyperglycemia, and pneumonitis). We associate these toxicities with survival and then evaluate these findings in a larger national cohort (Flatiron Health Research Database [FHRD]).</div></div><div><h3>Results</h3><div>We find that toxicities were common in the single-center cohort, with skin reaction (60%) and neuropathy (47%) most frequent, but toxicity-related discontinuation or hospitalization were less frequent (13%). Without a landmark analysis, multiple toxicities were linked to survival, but landmark analysis to address immortal time bias preserved only the skin reaction-survival association (Penn: HR = 0.28, 95% CI, 0.14-0.58; FHRD: HR = 0.69, 95% CI, 0.53-0.90).</div></div><div><h3>Conclusions</h3><div>These findings highlight the clinical relevance of EV ± P related toxicities, demonstrate the importance of accounting for immortal time bias in associations of these toxicities with survival, and add to a growing evidence base showing a survival association with skin toxicity in EV ± P treated patients. Future prospective studies are needed to evaluate skin toxicity as a favorable marker for survival.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102474"},"PeriodicalIF":2.7,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145770269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}