Dr. Galsky on Neoadjuvant Immune Checkpoint Blockade in Bladder Cancer

Matthew Galsky, MD, professor of medicine, hematology, and medical oncology, Mount Sinai Hospital, discusses neoadjuvant immune checkpoint inhibition in patients with bladder cancer.

Historically, chemotherapy has been the standard of care in the neoadjuvant setting, followed by cystectomy in patients with cisplatin-ineligible muscle-invasive bladder cancer (MIBC). Two trials presented at the 2018 ASCO Annual Meeting on neoadjuvant immune checkpoint blockade assessed either PD-1 or PD-L1 blockade in patients with MIBC. The only option for patients who are cisplatin-ineligible is surgery alone, Galsky says.

These studies are proof-of-concept and test whether single-agent immune checkpoint blockade can be administered in the neoadjuvant setting. Galsky says that both trials utilized pathologic complete response (pCR) rate as the primary endpoint. The pCR rate with 2 to 3 doses of immune checkpoint blockade prior to cystectomy was similar to what has been seen with combination cisplatin-based chemotherapy, reports Galsky. Although single-arm studies are rarely practice changing, Galsky says that these studies will inform further studies that may transform care.