Prognostic Impact of Skeletal Muscle Radiodensity in Advanced Urothelial Carcinoma Undergoing Avelumab Maintenance Therapy.

BACKGROUND/AIM: A significant survival benefit was found for avelumab maintenance therapy versus best supportive care in patients with advanced urothelial carcinoma who attained disease control after platinum-based chemotherapy in the JAVELIN Bladder 100 trial. Although patients generally tolerate avelumab maintenance therapy, some patients experience rapid progression and prognostic factors are not well established.

PATIENTS AND

METHODS

In this retrospective study, we investigated the prognostic significance of computed tomography-derived body composition indicators in 57 patients with advanced urothelial carcinoma who received avelumab maintenance therapy after first-line platinum-based chemotherapy. These patients were from within a cohort of 85 patients who underwent first-line platinum-based chemotherapy. Patients were divided into two groups based on a low or high skeletal muscle radiodensity (SMD). Prognostic factors were determined using univariate and multivariate analyses.

RESULTS

Among patients treated with avelumab, median progression-free survival (PFS) was 6.4 months in the high SMD group versus 4.8 months in the low skeletal muscle radiodensity group, while median overall survival (OS) was not reached versus 16.7 months, respectively. In a Cox proportional hazards model, only low SMD indicated a worse prognosis for PFS [hazard ratio (HR)=2.07, 95% confidence interval (CI)=1.06-4.04], while low SMD plus a high neutrophil-lymphocyte ratio were independent predictors for worse OS (HR=2.29, 95%CI=1.04-5.05 and HR=2.44, 95%CI=1.11-5.37, respectively).

CONCLUSION

SMD is a potential prognostic factor for advanced urothelial carcinoma cases undergoing avelumab maintenance therapy.