Role of Body Mass Index and concomitant medication use in metastatic urothelial carcinoma

The obesity paradox is a peculiar phenomenon whereby patients that are obese tend to survive longer, if affected by certain diseases, such as cancer.
While this phenomenon has been demonstrated in certain malignancies, the obesity paradox in patients with metastatic urothelial carcinoma (e.g. bladder cancer that has spread to other parts of the body) has not yet been investigated. If proven true, body mass index (BMI) categories, as per the World Health Organization (WHO), could represent a novel stratification factor for randomization for patients enrolled in future prospective trials and aid in study design.
Beta blockers are medications that are given to treat hypertension or following coronary artery disease (e.g. miocardial infaction). It has been demonstrated in patients with metastatic melanoma a synergistic effect of beta blockers and immunotherapy, meaning that patients that receive beta blockers and are on immunotherapy tend to achieve a greater degree of response to immunothreapy. This is due to the fact that beta blockers can enhance the activity of white blood cells that are the same target of immunotherapy for cancer. If proven true, in the context of metastatic urothelial carcinoma, one could advise on the use of beta blockers to all patients with hypertension or coronary syndromes instead of other alternative medications. The investigators are going to explore also the role of concomitant use of corticosterois, especially in case of the occurrence of ummune-related adverse events and anti-histamine medications.