Dr. Iyer on Advice for Physicians Using Immunotherapy in Bladder Cancer

Gopa Iyer, MD, assistant attending physician, Memorial Sloan Kettering Cancer Center, discusses significant points for community oncologists to be aware of when treating patients with bladder cancer with immunotherapy agents.

One of the main advantages of immunotherapy, Iyer says, is that it is associated with durable responses. Although the overall response rates with these agents have been relatively low, between 15% and 24%, studies are starting to show that 70% to more than 80% of those patients are responding to treatment for up to 1 year out. This speaks to the durability of response and tolerability from immunotherapy, Iyer says.

However, in a small percentage of patients, it can appear as if they are progressing on their disease, Iyer explains.

For example, after 3 treatments with atezolizumab (Tecentriq), physicians may notice that lesions have increased in size, though patents seem to be clinically benefiting from treatment. This is likely a case of pseudo progression, in which the immune cells are starting to infiltrate and attack the tumor. Many of these patients will continue on treatment despite this, as long as they are gaining clinical benefit.

On a follow-up scan after another 3 months, he explains, it is likely that oncologists will observe tumor shrinkage.