Evolution of front-line immunotherapy for metastatic urothelial cancer
Mené sur 1 123 patients atteints d'un carcinome urothélial de stade localement avancé ou métastatique (durée médiane de suivi : 13,4 mois), cet essai multicentrique de phase III compare l'efficacité, du point de vue de la survie globale, et la toxicité de trois stratégies thérapeutiques de première ligne : atézolizumab en monothérapie, chimiothérapie à base de sels de platine, atézolizumab en combinaison avec une chimiothérapie
In The Lancet Oncology, Enrique Grande and colleagues 1 and Aristotelis Bamias and colleagues 2 report the final results of IMvigor 130, a clinical trial exploring the role for checkpoint inhibition in the front-line treatment of locally advanced or metastatic surgically unresectable urothelial carcinoma. The investigators studied the use of atezolizumab as a single agent (group B) and in combination with standard-of-care platinum-based chemotherapy (group A), compared with placebo plus platinum-based chemotherapy (group C), in patients with previously untreated locally advanced or metastatic urothelial cancer. Despite the previously reported improvement in progression-free survival with first-line combination of atezolizumab plus platinum-based chemotherapy versus placebo plus platinum-based chemotherapy in the primary analysis (stratified hazard ratio [HR] 0·82 [95% CI 0·70–0·96]; one-sided p=0·007), 3 this did not translate into an improvement in overall survival (median overall survival was 16·1 months [95% CI 14·2–18·8; 336 death] in group A vs 13·4 months [12·0–15·3] in group C; stratified HR 0·85 [95% CI 0·73–1·00]; one-sided p=0·023).
The Lancet Oncology , commentaire, 2022