ArticleFrontiers in oncology2024
Effectiveness and safety of pembrolizumab, nivolumab, and atezolizumab as adjuvant therapy for high-risk muscle-invasive urothelial carcinoma: an indirect comparison.
Article in Frontiers in oncology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
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Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Role of tumor mutational burden in patients with urothelial carcinoma treated with immune checkpoint inhibitors: a systematic review and meta-analysis.Frontiers in immunology · 2025Pooled it
- E2F3 activates NF-κB signaling through TRIM26 mediated TAB1 ubiquitination in pancreatic cancer.International journal of biological sciences · 2026Article
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8 authors.
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Abstract
Background: The effectiveness of immune checkpoint inhibitors (ICIs) as adjuvant therapy for muscle-invasive urothelial carcinoma (MIUC) with high recurrence risk has been demonstrated. With no direct efficacy comparisons available, we aimed to indirectly compare the efficacy and safety of pembrolizumab, nivolumab, and atezolizumab as adjuvant treatments for high-risk MIUC based on individual patient data (IPD) from clinical trials. Methods: IPD was reconstructed using the Shiny method from Kaplan-Meier curves of eligible randomized controlled trials. We compared disease-free survival (DFS), overall survival (OS), PD-L1 positive DFS between treatments, and assessed treatment-related adverse events (TRAE). Results: Four studies including 2,220 high-risk MIUC patients showed no statistically significant difference between the three agents in terms of DFS (pembrolizumab vs. nivolumab: HR 0.97, 95% CI 0.79-1.18; pembrolizumab vs. atezolizumab: HR 0.85, 95% CI 0.70-1.04; nivolumab vs. atezolizumab: HR 0.90, 95% CI 0.74-1.10). All three agents showed comparable DFS outcomes in PD-L1 positive patients (pembrolizumab vs. nivolumab: HR 1.16, 95% CI 0.83-1.60; pembrolizumab vs. atezolizumab: HR 0.85, 95% CI 0.84-1.14; nivolumab vs. atezolizumab: HR 0.79, 95% CI 0.57-1.09), with similar DFS rates 24- and 36-months post-treatment (pembrolizumab: 53.3% and 46.8%; nivolumab: 48.5% and 44.8%; Atezolizumab: 45.0% and 40.7%). OS data showed no significant differences between pembrolizumab and nivolumab (HR 1.16, 95% CI: 0.90-1.49), pembrolizumab and atezolizumab (HR 1.02, 95% CI: 0.81-1.30), and nivolumab and atezolizumab (HR 0.87, 95% CI: 0.69-1.09). TRAE incidence varied but remained manageable (any grade: 26.4% pembrolizumab, 78.6% nivolumab, 54% atezolizumab; grade ≥3: 21.8% pembrolizumab, 18.2% nivolumab, 16.0% atezolizumab). Conclusions: All three agents showed similar efficacy with manageable safety profiles, positioning them as promising adjuvant therapies for MIUC. These results provide an evidence-based framework for clinical decision-making despite the lack of direct comparative data.
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