Immune checkpoint inhibitors deliver comparable effectiveness in advanced urothelial carcinoma

The effectiveness of programmed cell death protein 1 or its ligand (L1) inhibitors is similar as regards time to initiation of third therapy or death and overall survival in patients with platinum refractory locally advanced/unresectable or metastatic urothelial carcinoma, a recent study has shown.

“Five programmed cell death protein 1 or L1 inhibitors are approved for treatment of platinum refractory, locally advanced/unresectable or metastatic urothelial carcinoma,” the authors said. “However, their comparative effectiveness is unknown.”

Patient-level data were extracted from a real-word de-identified database and assessed comparative effectiveness using Cox proportional hazards model, weighted by matching weights. Each patient’s propensity for each treatment was modeled by random forest, based on potential drivers of treatment selection. Matching weight was calculated using a propensity score for each therapy, targeting the same estimand as 1:1 matching of treatment groups with balance among potential confounders.

A total of 609 patients met the eligibility criteria, which included diagnosis of metastatic urothelial carcinoma, receipt of first-line treatment with a platinum-based chemotherapy, followed by initiation of single-agent programmed cell death protein 1/L1 inhibitor after disease progression after 1 August 2016 through 1 May 2019.

Median time to initiation of third therapy or death was 4.2 months with atezolizumab, 5.3 months with nivolumab, and 4.5 months with pembrolizumab; median overall survival was 6.4, 8.0, and 8.3 months, respectively.

In matching weighted analysis, no significant differences were seen among programmed cell death protein 1/L1 inhibitors in terms of time to initiation of third therapy or death and overall survival.