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Immunotherapy in advanced urothelial cancer: first steps, multidisciplinary approach

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Presented at
Global Congress On Bladder Cancer

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Presentation

Abstract

Introduction:
Immunotherapy has become a therapeutic strategy that has changed the natural history of several tumors. Data on the expression of PDL-1 among other immunological biomarkers, have allowed the development of modern immunotherapeutics in the treatment of urothelial cancer for those patients whose disease progresses after chemotherapy treatment or are not Fit for it.
Material and methods:
We present our series of 15 patients treated with immunotherapy for urothelial cancer. Review of the characteristics of the sample, toxicity and overall survival.
Results:
15 patients with a mean age of 69 years, in a range between 55 and 85 years, have been treated. 14 males and 1 female. 14 of the cases have their origin in the bladder and one in the renal pelvis. Most are ECOG 0-1. Out of the 14 patients with bladder cancer, 12 with stage IV: 7 underwent cystectomy. 4 were treated with immunotherapy for being unfit for chemotherapy regimens and 10 after disease progression. The patient with urothelial cancer of the upper urinary tract was treated with chemotherapy and immunotherapy was indicated after progression. 6 of the patients have died. The average overall survival of these patients was 2.5 months. 10 months for nivolumab, 5 months for pembrolizumab, and 1.5 months for atezolizumab. The immunotherapy associated toxicity profile is related to the immune system. Most had fatigue, a diabetic debut?? and skin reactions were also observed. Three serious adverse reactions have been detected that required discontinuing the treatment. Pulmonary embolism with Pembrolizumab, a colitis that required admission and severe cholangitis. Immunotherapy toxicity requires multidisciplinary management, supported by endocrinology, dermatology, pulmonology, digestive, etc.
Conclusions:
The majority of toxicities observed are Grade I (fatigue). Treatment has been discontinued in 3 of the cases due to severe toxicity (colitis, cholangitis and PE). The immunotherapy toxicity profile requires multidisciplinary management (dermatology, endocrinology, etc.).
In our experience, the overall survival is 2.5 months on median. Underway Clinical trials working hand in hand with translational research allow us to continue defining the role of immunotherapy in this type of tumors.

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