Chemotherapy is superior to checkpoint inhibitors after radical surgery for urothelial carcinoma: a systematic review and network meta-analysis of oncologic and toxicity outcomes.

Abstract

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.

• Authors: Ekaterina Laukhtina, Reza Sari Motlagh, Keiichiro Mori, Satoshi Katayama, Pawel Rajwa, Takafumi Yanagisawa, Fahad Quhal, Hadi Mostafaei, Nico C Grossmann, Frederik König, Abdulmajeed Aydh, Benjamin Pradere, Irene Resch, Axel S Merseburger, Dmitry Enikeev, Shahrokh F Shariat
• Journal: Critical reviews in oncology/hematology (Crit Rev Oncol Hematol) Vol. 169 Pg. 103570 (Jan 2022) ISSN: 1879-0461 [Electronic] Netherlands
• PMID: 34902554 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.

Topics

• Antineoplastic Combined Chemotherapy Protocols (adverse effects)
• Bayes Theorem
• Carcinoma, Transitional Cell (drug therapy, surgery)
• Humans
• Network Meta-Analysis
• Urinary Bladder Neoplasms (drug therapy, surgery)