Petros Grivas, MD, PhD
For patients with locally advanced or metastatic bladder cancer who are cisplatin-ineligible, treatment options are limited, making clinical trials invaluable to further developments, explained Petros Grivas, MD, PhD.
on Genitourinary Cancers, Grivas, director, University of Washington Medicine’s Genitourinary Cancers Program, associate professor of Oncology, University of Washington, Seattle Cancer Care Alliance, discussed the rapidly evolving locally advanced and metastatic bladder cancer field.
OncLive: What has changed in the management of localized bladder cancer in recent years?
: It's an exciting era in the management of bladder cancer, and specifically, in the localized disease setting. Thus far, we have Level I evidence for cisplatin-based neoadjuvant chemotherapy before radical cystectomy and lymph node dissection. However, many patients may not be fit enough to receive cisplatin. Right now, those patients go right to the operating room to get radical cystectomy because there's no good evidence [to support the use of] carboplatin or other agents.
We also have patients who come to us after receiving a radical cystectomy. They never had neoadjuvant chemotherapy, or they received it and they still had muscle-invasive residual disease. If those patients are fit for cisplatin and have PT3-4 or node-positive disease, we tend to offer them cisplatin-based adjuvant chemotherapy. However, if they cannot receive cisplatin safely, refuse it, or already received it neoadjuvantly, we have these immunotherapy trials. There are trials [currently] looking at single-agent checkpoint inhibition in the adjuvant setting after radical cystectomy and lymph node dissection.
Is bladder preservation an option for these patients?
There is a significant effort going into improving upon the data with bladder preservation. We've used concurrent chemotherapy and radiation and chemoradiation as a backbone. We have this intergroup trial with SWOG, NRG Oncology, ECOG, ACRIN, and ALLIANCE looking at chemoradiation alone or chemoradiation plus atezolizumab (Tecentriq) to see whether the combination could improve upon bladder intact disease-free survival and other endpoints. If this trial accrues well, it will give us more data on bladder preservation.
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