Efficacy and Choice of Drug Therapy for Locally Advanced or Metastatic Bladder Cancer with Concurrent Chronic Kidney Disease Stage II-IV

Introduction. Bladder cancer is one of the most common types of cancer globally and in Russia. It ranks 10th in terms of prevalence. Current clinical guidelines offer limited information about treating bladder cancer in patients with chronic kidney disease (CKD). The only direct prohibition is the use of cisplatin in patients with impaired renal function and a glomerular filtration rate (GFR) of less than 50–60 ml/min. There are two main approaches for treating patients with bladder cancer and CKD: non-platinum chemotherapy regimens combined with antimetabolites, or immunotherapy using anti-PD1 antibodies. Objective: to select the optimal anticancer drug therapy strategy for patients with advanced bladder cancer and concomitant CKD. Materials and Methods. A retrospective study involving 84 patients with locally advanced or metastatic bladder cancer and chronic kidney disease (CKD) stages II–IV was conducted. Patients were included if they received first-line therapy with one of the following regimens: gemcitabine 800 mg/m² intravenously (IV) on days 1, 8, and 15, repeated every 4 weeks, or atezolizumab 1200 mg once every 3 weeks. Patients receiving atezolizumab were further divided into subgroups based on PD-L1 expression level (negative or ≥5%). The control group consisted of similar patients with preserved renal filtration function who received dual therapy (cisplatin + gemcitabine). Results. The median progression-free survival in the group of patients with concomitant CKD was 2.2 months, which was shorter than in the control group (7.4 months, p<0.05). One-year overall survival was also higher in the control group (30% vs. 52.9%, p<0.05). In patients with PD-L1 positive expression (≥5%) and stage II-IV CKD, atezolizumab monotherapy demonstrated greater efficacy compared to gemcitabine monotherapy. This was demonstrated based on one-year overall survival (66.7% vs. 30%, p<0.05) and median progression-free survival (9.2 months vs. 2.2 months, p<0.05). In patients with negative PD-L1 expression, atezolizumab was comparable in efficacy to gemcitabine monotherapy. Conclusion. Using atezolizumab in patients with PD-L1 expression of at least 5% showed significant advantages over gemcitabine monotherapy in terms of median progression-free survival and one-year overall survival. These results underscore the importance of determining PD-L1 status to personalize treatment for this patient population. However, empirical therapy with atezolizumab is not clinically justified.