Kelly L. Stratton, MD,
Over the past 10 years, a shift in cancer treatment has occurred with the approvals of immune-targeted treatments. At approximately the same time that the urology community was responding to the first therapeutic cancer vaccine approval—sipuleucel-T (Provenge) for castration-resistant metastatic prostate cancer—checkpoint inhibition was found to cause tumor regression.1,2
Since then, immunotherapy has become a rapidly growing focus for cancer treatment.
Clinical trials have produced paradigm-shifting results, resulting in immunotherapy becoming a common treatment option in urologic cancers. Although initial approvals have been for late-stage disease after first-line therapy has failed, immunotherapy is more commonly being used earlier in the treatment plan. As immunotherapy has become increasingly utilized, urologists are more frequently participating in the management of patients who are receiving immunotherapy.
The generally well-tolerated treatments are a departure from prior aggressive cytotoxic chemotherapy regimens. The methodical movement of immunotherapy trials into earlier disease states (ie, nonmuscle-invasive bladder cancer [NMIBC]), along with the minimal or no adverse events (AEs) of immunotherapy, has generated interest among urologists who are considering management of immunotherapy agents in their own patients. In this article, we will explore some immunotherapy agents and consider the management of AEs from the urologist’s perspective.
Immunotherapy agents are often referred to as checkpoint inhibitors and include both the PD-1 and PD-L1 inhibitors along with anti–CTLA-4 agents. The first approved drug in the urologic setting was nivolumab (Opdivo), an anti–PD-1 monoclonal antibody approved for second-line therapy in metastatic renal cell carcinoma. The first approved immunotherapy agent for metastatic bladder cancer was atezolizumab (Tecentriq), a PD-L1–targeting immunotherapy.
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