Dr. Sonpavde on Immunotherapy After Progression in Advanced Bladder Cancer

Guru P. Sonpavde, MD, director, Bladder Cancer, and physician, Dana-Farber Cancer Institute, discusses the use of immunotherapy after progression on platinum-based therapy in advanced bladder cancer.

There are 5 FDA-approved checkpoint inhibitors for patients who progress on platinum-based chemotherapy. Pembrolizumab (Keytruda) is the only agent among them that has level 1 data to support its use in this setting. However, there are 4 additional agents that can be used, and durvalumab (Imfinzi) is one of them, says Sonpavde. It is difficult to compare these agents across trials, especially since durvalumab was approved based on data from a large nonrandomized phase II trial. However, in that trial, the agent showed a similar incidence of grade ≥3 toxicities, ranging from 10% to 15%.

In terms of patient selection, pembrolizumab has the most robust data to support its use. Its approval was based on data from the phase III KEYNOTE-045 trial, in which the PD-1 inhibitor was superior to chemotherapy regardless of PD-L1 expression. All the other agents are approved based on nonrandomized phase II data, showing responses in the 15% to 25% range, with durable responses, says Sonpavde. Notably, atezolizumab (Tecentriq) was not found to be superior to chemotherapy in the phase III trial.