Dr. Grivas on Attempts to Improve Upon Chemotherapy in Urothelial Cancer

Petros Grivas, MD, PhD, physician, Seattle Cancer Care Alliance, associate professor, Division of Medical Oncology, University of Washington (UW) School of Medicine, clinical director, Genitourinary Cancers Program, UW Medicine, associate member, Clinical Research Division, Fred Hutchinson Cancer Center, discusses attempts to improve upon chemotherapy as a therapeutic strategy in urothelial cancer.

The field of urothelial cancer continues to evolve with multiple attempts to improve upon chemotherapy alone in the frontline setting, Grivas says. Cisplatin-based chemotherapy has produced encouraging results with response rates of about 55%; however,improvement is needed, Grivas adds. Response rates with gemcitabine and carboplatin are about 40% to 45%, Grivas says. Historically, the median progression-free survival with chemotherapy in urothelial cancer has been between 7 and 8 months, whereas overall survival (OS) has been around 15 months, Grivas explains.

In recent years, studies, such as the phase 3 IMvigor130 (NCT02807636) and KEYNOTE-361 (NCT02853305) trials, have evaluated chemotherapy in combination with immunotherapy, Grivas says. IMvigor130 evaluated atezolizumab (Tecentriq) and KEYNOTE-361 evaluated pembrolizumab (Keytruda), both in combination with platinum-based chemotherapy for patients with urothelial carcinoma. However, both trials failed to demonstrate a statistically significant OS benefit with chemoimmunotherapy vs chemotherapy alone, Grivas concludes.