Andrea Apolo, MD
The undoubtable highlight of 2017 in bladder cancer is the bundle of FDA-approved PD-1/PD-L1 inhibitors. While these achievements are worth noting, Andrea Apolo, MD, stresses the importance of recognizing and managing immune-related toxicities associated with their use.
during the 2017 Society of Urologic Oncology Annual Meeting, Apolo, chief of the Bladder Cancer Section of the Genitourinary Malignancies Branch at the National Cancer Institute, discussed these immune-related AEs, advised urologists on optimal management, and reflected on 2017 successes in bladder cancer.
OncLive: This was a banner year for bladder cancer. What have been the biggest advances?
: 2017 has been a big year for bladder cancer with multiple FDA approvals of checkpoint inhibitors for the treatment of this disease. A lot of the exciting things that we are seeing now are combination therapies and how these [checkpoint inhibitors] are being moved to earlier states of disease, such as non-muscle invasive bladder cancer and muscle invasive bladder cancer. We know what the efficacy is for monotherapy, so we are trying to do better. It is important to look out for toxicity in these combination regimens, but it is really exciting to take 2 active agents together and see the efficacy in patients with advanced bladder cancer. [Combinations] are also being looked at in non-advanced bladder cancer, as well.
Can you discuss the management of immune-related toxicity with checkpoint inhibitors in bladder cancer?
This year, at the 2017 SUO Annual Meeting, I was asked to talk about immune-related toxicities for patients with bladder cancer receiving checkpoint inhibitors. This is an important topic for urologists, because one of the strategies that we are doing as [investigators], now that we have seen activity in the second-line setting, is to move these agents to an earlier state of disease, such as muscle-invasive and non-muscle invasive bladder cancer. Urologists will be seeing these patients treated with checkpoint inhibitors in their clinic, so it is important that they know how to manage these toxicities.
Can you share your insight on how to manage these toxicities?
One of the most important things about managing an immune-related toxicity is recognizing it early. Most immune-related toxicities are easily manageable; however, there are rare, serious, life-threatening toxicities that need to be recognized early. I say: educate the patient, educate the nurses, and make sure that they pick up on subtleties. A lot of these AEs can be non-specific, such as fatigue and headache. It is important to recognize these early so that you can intervene early.
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