Dr. O'Donnell on PD-L1 Testing in Bladder Cancer

Peter O’Donnell, MD, associate professor of medicine, University of Chicago Medicine, discusses PD-L1 testing in patients with bladder cancer.

PD-L1 testing is now required if a physician is considering using immunotherapy in the frontline setting for a cisplatin-ineligible patient with bladder cancer. It is also required if a physician plans on using immunotherapy in a patient who is chemotherapy-eligible, notes O’Donnell. However, if a patient is eligible to receive gemcitabine/carboplatin, O’Donnell tends to opt for that regimen over immunotherapy.

PD-L1 testing can also be used for patients who could receive either approach. If that type of patient is PD-L1—positive, O’Donnell recommends immunotherapy, whereas a patient who is PD-L1–negative might do better with gemcitabine/carboplatin, states O’Donnell.

Moreover, incorporating PD-L1 testing into practice is especially important following the FDA’s warning in May 2018 cautioning against the frontline use of single-agent immunotherapy, specifically pembrolizumab (Keytruda) or atezolizumab (Tecentriq), in PD-L1—low expressing platinum-eligible patients with advanced urothelial carcinoma.