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Bellmunt Addresses Immunotherapy Advances, Challenges in Bladder Cancer

Brandon Scalea
Published: Tuesday, Jan 08, 2019

Joaquim Bellmunt MD, PhD

Joaquim Bellmunt MD, PhD
Checkpoint inhibitors have been rapidly approved by the FDA for the treatment of patients with metastatic bladder cancer, leaving a challenge of how to determine an optimal sequence. For guidance, community oncologists should refer to 2 pivotal trials, according to Joaquim Bellmunt, MD, PhD.

, Bellmunt provided insight on how to navigate the complex treatment paradigm of metastatic bladder cancer.

OncLive: What are the latest advances in the treatment of patients with metastatic bladder cancer?

Bellmunt: We have a wealth of new opportunities for patients. In fact, we have seen that in the span of just 1 year, there have been 7 FDA approvals for immunotherapy agents in this space. Five drugs were approved for second-line treatment for patients who progress on platinum-based chemotherapy; two of these drugs were approved for the frontline treatment of patients who are ineligible for chemotherapy.

Which checkpoint inhibitor should be the first choice for treatment?

We have no head-to-head comparisons. The approvals were based mainly on phase I and II clinical trials where we saw the responses were highly durable. The survival benefit also made it worth it to use these agents. We need to move on to the era of phase III trials, and we currently have 2 of these ongoing. We can say the only one that has demonstrated a clear survival advantage is the KEYNOTE-045 trial, which compared pembrolizumab with standard chemotherapy for second-line treatment. This trial showed superiority for the checkpoint inhibitor versus chemotherapy. The quality of life was also much better for the patients who received immunotherapy.
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