Immunotherapy Changes Early-Stage Urothelial Carcinoma Paradigm

Jason Harris
Published: Tuesday, Dec 11, 2018
Noah M. Hahn, MD

Noah M. Hahn, MD

Since 2016, the FDA has approved 5 immune checkpoint inhibitors (ICIs) to treat urologic cancers. Although that is a good thing for patients, the rise of these agents means that the role of the urologist in cancer is changing, Noah M. Hahn, MD, said during the 2018 Large Urology Group Practice Association (LUGPA) Annual Meeting, held November 1-3 in Chicago, Illinois. Newer agents are changing traditional strategies for care, resulting in higher levels of collaboration.

The trial also provided supporting evidence that immunotherapy is generally better tolerated that chemotherapy, Hahn pointed out. In KEYNOTE-045, the incidence of treatment-related adverse events (TRAEs) was lower with pembrolizumab for any grade (60.9% vs 90.2%) and grade 3/5 (15.0% vs 49.4%). The discontinuation rate resulting from TRAEs was 5.6% in the pembrolizumab arm and 11% in the chemotherapy arm.

Figure: Early Stage Bladder Cancer is Less Challenging to Treat

Figure: Early Stage Bladder Cancer is Less Challenging to Treat

Immunotherapy in MIBC and NMIBC

With the success of ICIs in metastatic disease—not just pembrolizumab, but also atezolizumab (Tecentriq), durvalumab (Imfinzi), and others—investigators have sought to determine if these agents can produce better outcomes in patients with earlier-stage bladder cancer, when the disease is less invasive (FIGURE). Several ongoing studies are exploring whether immunotherapy could be effective in patients with muscle invasive or nonmuscle invasive bladder cancer (MIBC/NMIBC).
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