Guru P. Sonpavde, MD, is the medical director for Genitourinary (GU) Oncology, assistant director of the Clinical Research Unit, and the Christopher K. Glanz Chair for Bladder Cancer Research at AdventHealth Cancer Institute.

Guru P. Sonpavde, MD, director, Bladder Cancer, and physician, Dana-Farber Cancer Institute, discusses therapeutic agents under investigation for patients with PD-L1—low bladder cancer.

There are trials being planned in that patient population, says Sonpavde, and time will tell whether or not the combination of chemotherapy and PD-1/PD-L1 inhibitors will be valuable in this setting. This approach also being looked at in ongoing phase III trials enrolling both cisplatin-eligible and -ineligible patients.

In addition, there is an Intergroup trial for cisplatin-ineligible patients that is comparing the combination of cisplatin and gemcitabine with or without bevacizumab (Avastin) or placebo. Those results are pending, adds Sonpavde. Finally, investigators are also looking into a “kitchen sink” approach in which several agents are being combined together, including durvalumab (Imfinzi) and tremelimumab—a PD-L1 inhibitor and a CLTA-4 inhibitor&mdash;plus platinum-based chemotherapy, compared with chemotherapy, or chemotherapy plus PD-L1 inhibition alone.

Videos

Guru P. Sonpavde, MD, director, Bladder Cancer, and physician, Dana-Farber Cancer Institute, discusses therapeutic agents under investigation for patients with PD-L1–low bladder cancer.

Dr. Sonpavde on Agents Under Investigation in PD-L1-Low Bladder Cancer

Guru P. Sonpavde, MD, director, Bladder Cancer, and physician, Dana-Farber Cancer Institute, discusses key data with immunotherapy in metastatic bladder cancer.

Data from several frontline phase III trials are still pending, says Sonpavde. In most of these trials, investigators are combining checkpoint inhibitors with PD-L1 plus CTLA-4 inhibitors. The other strategy being explored is platinum-based chemotherapy plus PD-1/PD-L1 inhibitors. Physicians are still waiting to see what the data will show. Further, investigation into PD-1/PD-L1 inhibitors alone versus chemotherapy in the first-line setting is ongoing, adds Sonpavde.

In terms of PD-L1—low patients, single-agent atezolizumab (Tecentriq) and pembrolizumab (Keytruda) have both been shown to be inferior to chemotherapy with carboplatin and gemcitabine. Therefore, the FDA changed the labels of these agents, only allowing their use in patients who are PD-L1–high and cisplatin-ineligible. For cisplatin-ineligible patients who are PD-L1–low, gemcitabine and carboplatin is the advised frontline therapy.

Guru P. Sonpavde, MD

Articles

Dr. Sonpavde on Agents Under Investigation in PD-L1-Low Bladder Cancer

Dr. Sonpavde on Key Data With Immunotherapy in Metastatic Bladder Cancer