Validation of a drug-based score in advanced urothelial carcinoma treated with pembrolizumab

To validate a ‘drug score’ that stratifies patients receiving immunotherapy based on concomitant medications (antibiotics/proton pump inhibitors/corticosteroids) in urothelial carcinoma (UC). We assessed oncological outcomes according to the drug score in 242 patients with advanced UC treated with pembrolizumab. The drug score classified patients into three risk groups with significantly different survivals. Heterogeneous treatment effect analyses showed that the primary cancer site (bladder UC [BUC] or upper-tract UC [UTUC]) significantly affected the prognostic capability of the drug score; it significantly correlated with survivals in BUC, while there were no such correlations in UTUC. A drug score was examined in advanced UC treated with pembrolizumab and was validated in BUC but not in UTUC. Drug treatment for cancer may be weakened by other drugs. We checked whether some kinds of drugs really weakened the effect of drug treatment for cancer. We found that it was true for some kinds of cancer but not for other kinds. A concomitant drug-based score was validated in advanced urothelial cancer treated with pembrolizumab. It was validated in bladder cancer but not in upper-tract urothelial cancer.