Predicting efficacy in patients with locally advanced (LA)/metastatic urothelial carcinoma (mUC) treated with avelumab using machine learning and explainability approaches.

Authors

null

Patrizia Giannatempo

Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy

Patrizia Giannatempo , Vanja Miskovic , Matteo Piceni , Elisabetta Gambale , Marco Stellato , Achille Bottiglieri , Ferrari Bravo Walter , Simone Oldani , Marco Maruzzo , Davide Bimbatti , Alessia Mennitto , Sara Elena Rebuzzi , Chiara Mercinelli , Mariella Sorarù , Luca Galli , Carlo Messina , Roberto Iacovelli , Lorenzo Antonuzzo , Arsela Prelaj , Giuseppe Procopio

Organizations

Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy, Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy, Politecnico di Milano, Milan, Italy, Careggi University Hospital, Florence, Italy, Genitourinary Medical Oncology, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy, Istituto Oncologico Veneto, Padova, Italy, Oncology Unit 1, Istituto Oncologico Veneto, IOV-IRCCS, Padua, Italy, Division of Oncology, University Hospital Maggiore della Carità, Novara, Italy, Medical Oncology, Ospedale San Paolo, Savona, Italy, Ospedale San Raffaele, Milan, Italy, UO Oncologia, Ospedale di Camposampiero (PD), Camposampiero, Italy, UO Oncologia Medica 2 Universitaria Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy, Ospedale A.R.N.A.S Civico, Palermo, Italy, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy, Sodc Ematologia - Azienda Ospedaliera Careggi, Florence, Italy, Thoracic Oncology Unit, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy, Genitourinary Medical Oncology, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy

Research Funding

No funding sources reported

Background: Internationally avelumab is approved as maintenance therapy for patients (pts) with LA/mUC whose disease did not progress after 1L platinum-based chemotherapy. However, 54% of pts progressed on avelumab. Limited data are available on predictive biomarker of efficacy. Artificial intelligence (AI) methods are being increasingly investigated to generate predictive models applicable in clinical practice. In this study, we developed a set of machine learning (ML) classifiers and survival analysis algorithms using real-world data to predict response and progression free survival (PFS) in LA/mUC patients treated with avelumab. We also applied explainability to the developed algorithms. Methods: We prospectively collected real-world data from 115 pts receiving Avelumab from 2021 to 2022 treated in 20 institutions in Italy (MALVA dataset). In order to predict the efficacy of immunotherapy (IO), 2 different outcomes were studied: Objective Response Rate (ORR) and Progression Free Survival (PFS). The dataset was split between training and test set, with a 80%-20% ratio.The missing values were imputed using a Bayesian Ridge iterative imputer, fitted on the training set. Eight different classifier models were used for ORR: XGBoost (XGB), Logistic Regression (LR), Random Forest (RF), Multilayer Perceptron (MLP), Support Vector Machine (SVM), Adaboost (AB), Extra Trees (ET) and LightGBM (LGBM). Five ML survival analysis models were used to analyse PFS: Cox Proportional Hazards (CPH), Random Survival Forest (RSF), Gradient Boosting (GB), Extra Survival Trees (EST) and Survival Support Vector Machine (SSVM). Finally, SHAP values, an eXplainable AI (XAI) technique, were calculated to evaluate each feature and to explain the predictions. Results: According to clinical expertise, 31 features were selected through a clinical hypothesis. For ORR prediction, the two best performing models were XGB and ET, both without using oversampling. On the test set, XGB achieved a F1 score of 0.77, accuracy of 0.77 and AUC of 0.81, while ET reached F1 score and accuracy of 0.81 and AUC of 0.80. Regarding the prediction of PFS, EST and RSF obtained the best performances with a c-index of 0.71 and 0.72, and Average AUC of 0.75 and 0.76, respectively. According to SHAP, the most important feature for predicting ORR was: ORR after 1st line CHT, while bone metastases, absolute leukocytes number at baseline and ECOG PS were the most important features for the PFS prediction. Conclusions: Machine learning is useful to predict efficacy in advanced urothelial carcinoma. The explainability models confirmed what have been discovered within the last years of immune-research conferring trustworthiness to the ML models. Further validation of these approaches on larger and external pts cohorts is needed.

Disclaimer

This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org

Abstract Details

Meeting

2024 ASCO Genitourinary Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session B: Urothelial Carcinoma

Track

Urothelial Carcinoma

Sub Track

Translational Research, Tumor Biology, Biomarkers, and Pathology

Citation

J Clin Oncol 42, 2024 (suppl 4; abstr 688)

DOI

10.1200/JCO.2024.42.4_suppl.688

Abstract #

688

Poster Bd #

L10

Abstract Disclosures