Dr. Grivas on Investigational Immunotherapy Approaches in Localized Bladder Cancer

Petros Grivas, MD, PhD, clinical director of the Genitourinary Cancers Program and associate professor, Department of Medicine, Division of Oncology, University of Washington, and medical oncologist, Seattle Cancer Care Alliance, discusses investigational immunotherapy approaches in localized bladder cancer.

Data presented by Andrea Necchi, MD, of Fondazione IRCCS Istituto Nazionale dei Tumori in Milan, and colleagues at the 2018 ASCO Annual Meeting and the 2018 ESMO Congress, showed a 50% pathologic complete response rate in patients with bladder cancer who had high PD-L1 and were given preoperative pembrolizumab (Keytruda). These data were not practice-changing, but they added to existing enthusiasm surrounding trials with neoadjuvant immunotherapy, explains Grivas.

Now, work is being done to bring immunotherapy agents to patients who are cisplatin-ineligible, pending confirmatory safety and efficacy data. Physicians may also be able to build upon cisplatin backbones as there are new trials comparing cisplatin plus immunotherapy versus cisplatin-based therapy alone, he adds.

Patients who develop PT3-4 or node-positive muscle-invasive residual disease and are fit for cisplatin are typically offered cisplatin-based adjuvant chemotherapy. However, if they cannot receive cisplatin safely, refuse it, or already received it neoadjuvantly, immunotherapy trials are open for enrollment—specifically, trials that are looking at single-agent checkpoint inhibition in the adjuvant setting after radical cystectomy and lymph node dissection, concludes Grivas.