Metastatic urothelial carcinoma (mUC) is a lethal disease with limited treatment options. We aimed to compare the treatment patterns and outcomes of patients with mUC who were treated before and after the introduction of immune checkpoint inhibitors (ICIs) at a tertiary hospital in Barcelona. Single-centre retrospective study from 2004 to 2021. Access to ICIs began in December 2014. We analysed differences in clinical characteristics and survival outcomes, such as overall survival (OS), progression-free survival (PFS), and restricted mean survival time (RMST). A total of 206 patients were included. The median follow-up was 48.6 months. Ninety and 116 patients were treated during the pre-ICIs and the post-ICIs eras, respectively. We found high treatment attrition rates, with no differences in the number of patients who received second-line (48%) and third-line (26%) therapies between the two eras. In the second-line, ICIs became the predominant therapy (58%), leading to a 30% reduction in the utilisation of platinum-based ChT and non-platinum ChT. Innovative approaches including ICIs in the first-line treatment (18%) and targeted therapies in the third-line setting (34%) were observed. We found no differences in the median OS, 2-year OS, or 24-month RMST between the two periods. ICIs have emerged as a transformative treatment option, reshaping the treatment landscape. Nevertheless, substantial attrition rates from first-line to subsequent lines of systemic therapies might impede the potential impact of ICIs on long-term survival outcomes across the entire population. Immune checkpoint inhibitors now serve as a novel treatment option for patients facing metastatic urothelial carcinoma, particularly in the second-line setting, thereby changing the treatment paradigm. Nonetheless, the substantial attrition rates during the transition from the first-line to subsequent lines of systemic therapy may hinder the potential impact of immune checkpoint inhibitors on long-term survival outcomes for the broader population.

中文翻译：

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转移性尿路上皮癌患者使用免疫检查点抑制剂前后的治疗模式和生存结果：2004 年至 2021 年的单中心回顾性研究。

转移性尿路上皮癌（mUC）是一种致命疾病，治疗选择有限。我们的目的是比较在巴塞罗那一家三级医院引入免疫检查点抑制剂 (ICIs) 前后接受治疗的 mUC 患者的治疗模式和结果。2004年至2021年的单中心回顾性研究。ICIs的使用于2014年12月开始。我们分析了临床特征和生存结果的差异，例如总生存期（OS）、无进展生存期（PFS）和限制平均生存时间（均方根标准）。总共纳入 206 名患者。中位随访时间为 48.6 个月。在 ICI 之前和 ICI 后时代分别有 90 名和 116 名患者接受了治疗。我们发现治疗流失率很高，两个时代之间接受二线（48%）和三线（26%）治疗的患者数量没有差异。在二线治疗中，ICIs 成为主要疗法 (58%)，导致铂类 ChT 和非铂类 ChT 的使用量减少 30%。观察到创新方法，包括一线治疗中的 ICI（18%）和三线治疗中的靶向治疗（34%）。我们发现两个时期之间的中位 OS、2 年 OS 或 24 个月 RMST 没有差异。ICI 已成为一种变革性的治疗选择，重塑了治疗格局。然而，从一线到后续系统治疗的大量流失率可能会阻碍 ICI 对整个人群长期生存结果的潜在影响。免疫检查点抑制剂现在成为转移性尿路上皮癌患者的一种新的治疗选择，特别是在二线环境中，从而改变了治疗模式。尽管如此，从一线系统治疗过渡到后续系统治疗期间的大量损耗率可能会阻碍免疫检查点抑制剂对更广泛人群的长期生存结果的潜在影响。