Elizabeth Plimack, MD

Elizabeth Plimack, MD, director of Genitourinary Clinical Research at Fox Chase Cancer Center, discusses the growth of immunotherapy for the treatment of patients with bladder cancer. 

The last FDA approval in bladder cancer prior to May 2016 was cisplatin in 1978. There has been a long drought in treatment development, which makes the recent FDA approvals and the growing interest in bladder cancer exciting, says Plimack. There are currently more trials than ever before, which will improve the care patients with bladder cancer receive.  

There will be more upcoming data that will advance the field forward. The current standard of care might not be the standard much longer, explains Plimack. Most recently, findings from the KEYNOTE-045 trial demonstrated a 27% reduction in the risk of progression or death when patients with advanced bladder cancer who had progressed after prior treatment were treated with pembrolizumab (Keytruda). 

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Elizabeth Plimack, MD, director of Genitourinary Clinical Research at Fox Chase Cancer Center, discusses the growth of immunotherapy for the treatment of patients with bladder cancer.

Dr. Plimack on the Growth of Immunotherapy in Bladder Cancer

Elizabeth Plimack, MD, director of Genitourinary Clinical Research at Fox Chase Cancer Center, discusses immunotherapy combinations for patients with bladder cancer.

There are trials that are in development investigating checkpoint inhibitors. For example, one is with an IDO inhibitor epacadostat plus pembrolizumab (Keytruda). There is also an IDO inhibitor being studied in combination with nivolumab (Opdivo) by Bristol-Myers Squibb, adds Plimack. The early phase I data with epacadostat and pembrolizumab was encouraging in terms of efficacy in patients with previously treated bladder cancer. That will be explored going forward.

Another combination is ipilimumab (Yervoy) and nivolumab. There are phase I basket data for that combination, but based on the efficacy and the durability of response in those patients, it has been investigated in a phase III trial, as well, explains Plimack. There are additionnal immunotherapy combinations that all need to be investigated further.

Dr. Plimack on Immunotherapy Combinations in Bladder Cancer

Elizabeth Plimack, MD, director of Genitourinary Clinical Research at Fox Chase Cancer Center, discusses recent trials in kidney cancer.

In findings from the phase III IMmotion151 study presented during the 2018 Genitourinary (GU) Cancers Symposium, the combination of atezolizumab (Tecentriq) and bevacizumab (Avastin) reduced the risk of progression or death by 26% compared with sunitinib (Sutent) for patients with untreated PD-L1—positive metastatic kidney cancer. This is one of the first trials of VEGF inhibition with PD-1 inhibition to read out, says Plimack.

Long-term single-arm data with the combination of axitinib (Inlyta) and pembrolizumab (Keytruda), another immunotherapy combination, was also recently presented at the 2018 GU Cancers Symposium. The combination showed superior antitumor activity to that expected from axitinib or PD-1/PD-L1 pathway inhibitor monotherapy in treatment-naïve patients with advanced kidney cancer. Best overall response was a complete response in 4 patients (7.7%), partial response in 34 (65.4%), and stable disease in 8 (15.4%). The median progression-free survival was 20.9 months (95% CI, 15.4-not evaluable).

Elizabeth Plimack, MD, director of Genitourinary Clinical Research at Fox Chase Cancer Center, discusses recent trials in kidney cancer.
 

Dr. Plimack Discusses Recent Trials in Kidney Cancer

Elizabeth Plimack, MD, director of Genitourinary Clinical Research at Fox Chase Cancer Center, discusses 2 studies reported at the 2018 Genitourinary Cancers Symposium in patients with nonmetastatic M0 castration-resistant prostate cancer (CRPC).

These patients show no evidence of metastatic disease on conventional imaging, but their PSA continues to rise, despite receiving androgen deprivation therapy, Plimack explains.

The phase III randomized, double-blind PROSPER study investigated enzalutamide (Xtandi) in these patients, and the phase III randomized, double-blind SPARTAN study looked at apalutamide (ARN-509).

Both trials showed a robust effect in terms of delay in time to metastases, but overall survival data have not yet shown a difference in treating early versus treating later. The question that remains is whether there is ultimately a long-term benefit in treating these patients earlier, in the M0 space, versus later, at M1, Plimack says.

Author | Elizabeth Plimack, MD

Articles

Dr. Plimack on the Growth of Immunotherapy in Bladder Cancer

Dr. Plimack on Immunotherapy Combinations in Bladder Cancer

Dr. Plimack Discusses Recent Trials in Kidney Cancer

Dr. Plimack Discusses Trials Investigating Apalutamide, Enzalutamide in M0 CRPC