{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T01:50:00Z","timestamp":1781229000318,"version":"3.54.1"},"reference-count":25,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2020,7,7]],"date-time":"2020-07-07T00:00:00Z","timestamp":1594080000000},"content-version":"unspecified","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007013","name":"F. Hoffmann-La Roche","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007013","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Immunother Cancer"],"accepted":{"date-parts":[[2020,5,4]]},"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Atezolizumab is a treatment for locally advanced\/metastatic urothelial carcinoma (mUC). However, its use in patients with renal insufficiency or UC with mixed variant histology (MVH) is not well characterized.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To report efficacy and safety of atezolizumab in these special subpopulations from an expanded access program (EAP).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design, setting, and participants<\/jats:title>\n                  <jats:p>A total of 218 patients were enrolled at 36 US study sites (November 2015\u2013August 2016), and the trial ended following the approval of atezolizumab by the US Food and Drug Administration. This post hoc analysis investigated outcomes in specific study subgroups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Intervention<\/jats:title>\n                  <jats:p>Atezolizumab 1200 mg was administered intravenously every 3 weeks until loss of clinical benefit, unacceptable toxicity, death, consent withdrawal, decision to discontinue, commercial availability, or study closure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcome measurements and statistical analysis<\/jats:title>\n                  <jats:p>Response Evaluation Criteria in Solid Tumors V.1.1 responses and safety were evaluated by baseline renal function and histology.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results and limitations<\/jats:title>\n                  <jats:p>Objective responses occurred in 0\/6 (0%), 4\/19 (21%), 1\/27 (3.7%), and 12\/62 (19%) of evaluable patients with creatinine clearance (CrCl) &lt;30, 30\u201345, 45\u201360, and \u226560 mL\/min, respectively, and stable disease was seen in three patients with CrCl &lt;30 mL\/min. Objective responses were seen in 13\/102 patients (13%) with urothelial carcinoma (UC) histology only and in 4\/12 patients (33%) with UC with MVH. Treatment-related adverse event frequencies ranged from 35% to 54% across the earlier indicated CrCl subgroups and they were also similar in patients with pure UC or UC with MVH (46%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In this EAP mUC subgroup analysis, clinical benefit of atezolizumab occurred in patients with compromised renal function or MVH UC tumors. Safety was comparable across subgroups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patient summary<\/jats:title>\n                  <jats:p>We examined the efficacy and safety of atezolizumab for UC in certain patients participating in an EAP. We found that responses to atezolizumab occurred, and safety was similar, in most patient subgroups with varying levels of kidney functioning or less common types of tumor tissue histology.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jitc-2019-000419","type":"journal-article","created":{"date-parts":[[2020,7,8]],"date-time":"2020-07-08T05:14:49Z","timestamp":1594185289000},"page":"e000419","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Atezolizumab in patients with renal insufficiency and mixed variant histology: analyses from an expanded access program in platinum-treated locally advanced or metastatic urothelial carcinoma"],"prefix":"10.1136","volume":"8","clinical-trial-number":[{"clinical-trial-number":"nct02589717","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Jean","family":"Hoffman-Censits","sequence":"first","affiliation":[{"name":"Departments of Oncology and Urology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumanta","family":"Pal","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constanze","family":"Kaiser","sequence":"additional","affiliation":[{"name":"Genentech Inc, South San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beiying","family":"Ding","sequence":"additional","affiliation":[{"name":"Genentech Inc, South San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joaquim","family":"Bellmunt","sequence":"additional","affiliation":[{"name":"Director, Bladder Cancer Program, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,7,7]]},"reference":[{"key":"2025100308401230000_8.2.e000419.1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdu223"},{"key":"2025100308401230000_8.2.e000419.2","unstructured":"NCCN Clinical Practice Guidelines in Oncology . Bladder cancer. V4, 2019. Available: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/bladder.pdf [Accessed 18 Sep 2019]."},{"key":"2025100308401230000_8.2.e000419.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)32455-2"},{"key":"2025100308401230000_8.2.e000419.4","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.07.757"},{"key":"2025100308401230000_8.2.e000419.5","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.34.8433"},{"key":"2025100308401230000_8.2.e000419.6","unstructured":"Surveillance, Epidemiology, and End Results Program . Cancer STAT facts: bladder cancer. Available: https:\/\/seer.cancer.gov\/statfacts\/html\/urinb.html [Accessed 18 Sep 2019]."},{"key":"2025100308401230000_8.2.e000419.7","unstructured":"Genentech, Inc . TECENTRIQ (atezolizumab) [package insert]. South San Francisco, CA: Genentech, Inc, 2019."},{"key":"2025100308401230000_8.2.e000419.8","unstructured":"Roche Registration Limited . TECENTRIQ (atezolizumab) [summary of product characteristics]. Welwyn Garden City, UK: Roche Registration Limited, 2018."},{"key":"2025100308401230000_8.2.e000419.9","doi-asserted-by":"publisher","DOI":"10.1038\/nature13904"},{"key":"2025100308401230000_8.2.e000419.10","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00561-4"},{"key":"2025100308401230000_8.2.e000419.11","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1001\/jamaoncol.2017.5440","article-title":"Atezolizumab (MPDL3280A) monotherapy for patients with metastatic urothelial cancer: long-term outcomes from a phase 1 study","volume":"4","author":"Petrylak","year":"2018","journal-title":"JAMA Oncol"},{"key":"2025100308401230000_8.2.e000419.12","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1016\/j.eururo.2018.02.010","article-title":"Atezolizumab in platinum-treated locally advanced or metastatic urothelial carcinoma: clinical experience from an expanded access study in the United States","volume":"73","author":"Pal","year":"2018","journal-title":"Eur Urol"},{"key":"2025100308401230000_8.2.e000419.13","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1007\/s00345-017-2139-9","article-title":"Renal function recovery after radical nephroureterectomy for upper tract urothelial carcinoma","volume":"36","author":"Lee","year":"2018","journal-title":"World J Urol"},{"key":"2025100308401230000_8.2.e000419.14","doi-asserted-by":"crossref","DOI":"10.1186\/s12894-017-0263-x","article-title":"Presence of transient hydronephrosis immediately after surgery has a limited influence on renal function 1\u00a0year after ileal neobladder construction","volume":"17","author":"Narita","year":"2017","journal-title":"BMC Urol"},{"key":"2025100308401230000_8.2.e000419.15","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.08070715"},{"key":"2025100308401230000_8.2.e000419.16","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198209093071104"},{"key":"2025100308401230000_8.2.e000419.17","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.22031"},{"key":"2025100308401230000_8.2.e000419.18","doi-asserted-by":"crossref","DOI":"10.1038\/srep35214","article-title":"Prognostic value of pre-operative renal insufficiency in urothelial carcinoma: a systematic review and meta-analysis","volume":"6","author":"Cao","year":"2016","journal-title":"Sci Rep"},{"key":"2025100308401230000_8.2.e000419.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2016.02.028"},{"key":"2025100308401230000_8.2.e000419.20","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s00345-018-2421-5","article-title":"Update of the International Consultation on Urological Diseases on bladder cancer 2018: non-urothelial cancers of the urinary bladder","volume":"37","author":"Alanee","year":"2019","journal-title":"World J Urol"},{"key":"2025100308401230000_8.2.e000419.21","doi-asserted-by":"crossref","first-page":"692","DOI":"10.21037\/tau.2016.06.13","article-title":"Variant histology in bladder cancer: how it should change the management in non-muscle invasive and muscle invasive disease?","volume":"5","author":"Klaile","year":"2016","journal-title":"Transl Androl Urol"},{"key":"2025100308401230000_8.2.e000419.22","doi-asserted-by":"crossref","unstructured":"Hunter L , Moser J , Sturge C , et al . 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