Dr. Powles on the Current State of Research in Bladder Cancer

Thomas Powles MBBS, MRCP, MD, professor of Genitourinary Oncology, lead, Solid Tumour Research, Barts Cancer Institute, director, Barts Cancer Centre, discusses the current state of research in bladder cancer.

Powles says that approved immunotherapy agents such as pembrolizumab (Keytruda) and atezolizumab (Tecentriq) should only be used in patients with bladder cancer who are biomarker-positive. That is the indication in which these agents have been approved, and administering immunotherapy to patients who are biomarker-negative can have hazardous outcomes. In light of a demonstration of lower overall survival with pembrolizumab and atezolizumab compared with platinum-based chemotherapy, the FDA issued a drug safety notification warning against the use of frontline single-agent immune checkpoint inhibition for patients with PD-L1—low expressing platinum-eligible urothelial carcinoma.

Additionally, Powles believes that this field is lagging behind, as frontline trials of checkpoint inhibitors in breast cancer and head and neck cancer are surpassing those of bladder cancer. There is some work being done looking at the stromal signature in bladder cancer, which may answer the question of why checkpoint inhibitors have not been as effective in the frontline setting of this disease compared with others.