There is a myriad of combinations that are running in phase I, II, and III studies worldwide in bladder cancer. We are combining different agents—immune checkpoint inhibitors with other immune checkpoint inhibitors, immune checkpoint with antiangiogenic drugs, or immune checkpoint inhibitors with personalized medicine. That is huge platter of possibilities for patients. This is, of course, an advantage and positive situation for patients with bladder cancer today.
What are the remaining challenges with immunotherapy in bladder cancer?
The biggest challenge for immunotherapy in bladder cancer remains in the very early stages. For example, in Milan, we are running a phase II study with pembrolizumab—the PURE-01 study—which is recruiting very fast. It provides a short course of administration of pembrolizumab—3 courses—and then radical cystectomy in all comers. Results are awaited next year. There is another very similar study, which provides administration of 2 courses of atezolizumab prior to radical cystectomy. We can really achieve a very important step forward from the biologic viewpoint [with these studies].
We have 3 big adjuvant randomized studies; the results from these studies are awaited, and, finally, we have multiple studies with single-agent or combination immunotherapy in Bacillus Calmette-Guerin-refractory patients in nonmuscle-invasive patients. The advent of new checkpoint inhibitors in this area will provide us with opportunity to work more closely and to better reach the way we globally treat patients with bladder cancer.