Dr. Balar on Remaining Questions With Immunotherapy in Bladder Cancer

Arjun V. Balar, MD, assistant professor, Department of Medicine, director, Genitourinary Medical Oncology Program, NYU Langone’s Perlmutter Cancer Center, discusses remaining questions with immunotherapy in bladder cancer.

Among the success that has been seen with immunotherapy in the bladder cancer space, questions on specific populations and novel combinations remain.

Patients with liver metastases do poorly with immunotherapy across the board, irrespective of the solid tumor type, Balar explains. These patients have shown response rates to immunotherapy from 8% to 15% in various studies. It is said that patients with FGFR3 do not do well with immunotherapy, which Balar notes is a controversial topic. He adds that these patients will need to be addressed moving forward. The role of CTLA4 blockade is still under question. Combinations of CTLA4 plus PD-1 blockade have shown improved responses, both in patients with high and low PD-L1 expression, Balar says.

The role for combination immunotherapy with platinum-based therapy is being tested in 2 large randomized trials in first-line bladder cancer. Many in the field expect to see this combination to become the new standard in the treatment of patients with advanced bladder cancer, Balar says.