Jonathan E. Rosenberg, MD
As immunotherapy continues to move its way through the treatment landscape of urothelial carcinoma, the optimal dosing of combination regimens continues to be investigated.
, Rosenberg, medical oncologist, chief of the Genitourinary Medical Oncology Service, Memorial Sloan Kettering Cancer Center, discussed these findings, as well as the future of immunotherapy in urothelial carcinoma.
OncLive: Could you provide some background on the CheckMate-032 trial?
CheckMate-032 is a multicohort study of patients with different disease types treated with either nivolumab alone or nivolumab in combination with ipilimumab. In bladder cancer, the trial enrolled patients who were previously treated with at least 1 regimen of platinum chemotherapy, then progressed and enrolled on either N3, N3/I1 for 4 cycles followed by nivolumab maintenance, or N1/I3 for 4 cycles followed by nivolumab maintenance.
What was interesting in the CheckMate-032 trial is that the patients who had high levels of PD-L1 staining had a much higher response rate in the N1/I3 cohort with a response rate of 58% compared with approximately 25% in low levels of PD-L1 expression. This suggests that PD-L1 staining might matter even in combination with ipilimumab, not just with first-line therapy with pembrolizumab (Keytruda) or atezolizumab (Tecentriq) in bladder cancer.
How will these findings impact the treatment of these patients moving forward?
The data supporting the higher dose of ipilimumab is leading to more activity with an acceptable toxicity profile. A higher dosing has about a 12% higher response rate, the duration of responses appears longer, and the OS—although the data are still premature—is about 15 months compared with about 8 or 9 months for patients treated with the other 2 regimens. It is a similar range for patients treated with atezolizumab or pembrolizumab in the second-line setting.
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