TY - JOUR
T1 - Chemotherapy is superior to checkpoint inhibitors after radical surgery for urothelial carcinoma
T2 - a systematic review and network meta-analysis of oncologic and toxicity outcomes
AU - Laukhtina, Ekaterina
AU - Sari Motlagh, Reza
AU - Mori, Keiichiro
AU - Katayama, Satoshi
AU - Rajwa, Pawel
AU - Yanagisawa, Takafumi
AU - Quhal, Fahad
AU - Mostafaei, Hadi
AU - Grossmann, Nico C.
AU - König, Frederik
AU - Aydh, Abdulmajeed
AU - Pradere, Benjamin
AU - Resch, Irene
AU - Merseburger, Axel S.
AU - Enikeev, Dmitry
AU - Shariat, Shahrokh F.
N1 - Funding Information:
Pawel Rajwa is supported by the EUSP Scholarship of the European Association of Urology (EAU). Nico C. Grossmann is supported by the Zurich Cancer League.
Publisher Copyright:
© 2021 The Author(s)
PY - 2022/1
Y1 - 2022/1
N2 - Objective: To determine the oncologic and toxicity outcomes of adjuvant immunotherapy with immune checkpoint inhibitors (ICIs) compared to adjuvant chemotherapy in patients treated with radical surgery for urothelial carcinoma (UC). Methods: We used the Bayesian approach in the network meta-analysis of different therapy regimens compared to observation or placebo. Results: Nine studies comprised of 2,444 patients met the eligibility criteria. In bladder UC, chemotherapy, atezolizumab, and nivolumab did not improve disease progression compared to observation/placebo. In upper tract UC (UTUC), chemotherapy was significantly associated with a lower likelihood of disease progression compared to observation/placebo, while atezolizumab and nivolumab were not. Based on the analysis of the treatment ranking, adjuvant chemotherapy appeared as the best treatment approach in both bladder UC and UTUC. The risk of adverse events with ICIs was comparable to that of observation/placebo. Conclusion: Our analysis suggests a superior oncologic benefit to adjuvant chemotherapy over ICIs in patients treated with radical surgery for both bladder UC and UTUC.
AB - Objective: To determine the oncologic and toxicity outcomes of adjuvant immunotherapy with immune checkpoint inhibitors (ICIs) compared to adjuvant chemotherapy in patients treated with radical surgery for urothelial carcinoma (UC). Methods: We used the Bayesian approach in the network meta-analysis of different therapy regimens compared to observation or placebo. Results: Nine studies comprised of 2,444 patients met the eligibility criteria. In bladder UC, chemotherapy, atezolizumab, and nivolumab did not improve disease progression compared to observation/placebo. In upper tract UC (UTUC), chemotherapy was significantly associated with a lower likelihood of disease progression compared to observation/placebo, while atezolizumab and nivolumab were not. Based on the analysis of the treatment ranking, adjuvant chemotherapy appeared as the best treatment approach in both bladder UC and UTUC. The risk of adverse events with ICIs was comparable to that of observation/placebo. Conclusion: Our analysis suggests a superior oncologic benefit to adjuvant chemotherapy over ICIs in patients treated with radical surgery for both bladder UC and UTUC.
KW - adjuvant therapy
KW - chemotherapy
KW - ICI
KW - PD-1
KW - PD-L1
KW - urothelial carcinoma
UR - http://www.scopus.com/inward/record.url?scp=85121099887&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85121099887&partnerID=8YFLogxK
U2 - 10.1016/j.critrevonc.2021.103570
DO - 10.1016/j.critrevonc.2021.103570
M3 - Review article
C2 - 34902554
AN - SCOPUS:85121099887
SN - 1040-8428
VL - 169
JO - Critical Reviews in Oncology/Hematology
JF - Critical Reviews in Oncology/Hematology
M1 - 103570
ER -