Dr. Grivas on Combining Chemotherapy and Immunotherapy in Bladder Cancer

Petros Grivas, MD, PhD, medical oncologist, Cleveland Clinic, discusses combining chemotherapy and immunotherapy as a treatment approach for patients with bladder cancer.

Chemotherapy alone has the potential to induce changes in a tumor microenvironment. Cleveland Clinic data indicated there was variability in PD-L1 and PD-L2 expression after neoadjuvant chemotherapy in patients. Some patients had a lower PD-L1/PD-L2 expression at the cystectomy specimens compared with the transurethral resection of bladder tumor specimens. Those who experienced increased or stable PD-L1 expression had earlier recurrence.

The combination of chemotherapy with immunotherapy may have synergistic results, says Grivas. There is also the theoretical concept of immunogenic cell death that needs to be further evaluated in clinical practice, explains Grivas.