(UroToday.com) The optimal first-line regimen for treatment-naive advanced urothelial cancer is undefined. This study presented by dr. Szabados used a de-identified Flatiron Health-Foundation Medicine
Incorporation (FH-FMI) of clinico-genomic database (CGDB) to try to investigate clinic-genomic biomarker predicting for response to chemotherapy. Data from ~280 US oncology centers were gathered. Information were extracted for patients with treatment naive advanced UC undergoing first line platinum-based chemotherapy. Clinical and genomic data were analyzed and correlated with overall survival (OS). Using the Cox-LASSO method, a novel performance index was developed.
From a total of 268 patients treated between between January 2011 and March 2020 were included. 77% (206/268) had documented metastatic disease and 43% had an ECOG performance status of 0. 54% and 46% received cisplatin and carboplatin containing regimens, respectively. Patients with tumors harboring high APOBEC mutational signatures had worse OS (HR 1.43 [95% CI, 1.06–1.94]; P=0.02). FGFR3 mutations and DNA damage-repair pathway alterations were not associated with improved OS. The median OS was 8.2 months (95%CI: 6.8 – 10.0). Using machine learning methods, a performance index was developed. Low albumin, low eGFR (<50ml/min), high APOBEC signature and mutation in LRP1B were associated with poor survival (mOS 4.7 months [95% CI, 2.9–7.9]; P<0.001).
This work showcases the possibility of using real-world data linked with comprehensive genomic profiling in developing a novel performance index to predict patients with poor outcomes following front-line platinum-based chemotherapy.
Presented by: Bernadett Szabados, MD, Barts Cancer Institute
Written by: Roger Li, Urologic Oncologist, Moffitt Cancer Center, during the International Bladder Cancer Network Annual Meeting, September 28-October 1, 2022, Barcelona, Spain