Dr. Sonpavde on Key Data With Immunotherapy in Metastatic Bladder Cancer

Guru P. Sonpavde, MD
Published: Friday, May 17, 2019



Guru P. Sonpavde, MD, director, Bladder Cancer, and physician, Dana-Farber Cancer Institute, discusses key data with immunotherapy in metastatic bladder cancer.

Data from several frontline phase III trials are still pending, says Sonpavde. In most of these trials, investigators are combining checkpoint inhibitors with PD-L1 plus CTLA-4 inhibitors. The other strategy being explored is platinum-based chemotherapy plus PD-1/PD-L1 inhibitors. Physicians are still waiting to see what the data will show. Further, investigation into PD-1/PD-L1 inhibitors alone versus chemotherapy in the first-line setting is ongoing, adds Sonpavde.

In terms of PD-L1–low patients, single-agent atezolizumab (Tecentriq) and pembrolizumab (Keytruda) have both been shown to be inferior to chemotherapy with carboplatin and gemcitabine. Therefore, the FDA changed the labels of these agents, only allowing their use in patients who are PD-L1–high and cisplatin-ineligible. For cisplatin-ineligible patients who are PD-L1–low, gemcitabine and carboplatin is the advised frontline therapy.
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Guru P. Sonpavde, MD, director, Bladder Cancer, and physician, Dana-Farber Cancer Institute, discusses key data with immunotherapy in metastatic bladder cancer.

Data from several frontline phase III trials are still pending, says Sonpavde. In most of these trials, investigators are combining checkpoint inhibitors with PD-L1 plus CTLA-4 inhibitors. The other strategy being explored is platinum-based chemotherapy plus PD-1/PD-L1 inhibitors. Physicians are still waiting to see what the data will show. Further, investigation into PD-1/PD-L1 inhibitors alone versus chemotherapy in the first-line setting is ongoing, adds Sonpavde.

In terms of PD-L1–low patients, single-agent atezolizumab (Tecentriq) and pembrolizumab (Keytruda) have both been shown to be inferior to chemotherapy with carboplatin and gemcitabine. Therefore, the FDA changed the labels of these agents, only allowing their use in patients who are PD-L1–high and cisplatin-ineligible. For cisplatin-ineligible patients who are PD-L1–low, gemcitabine and carboplatin is the advised frontline therapy.



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