Dr. Grivas on Checkpoint Inhibitors in Localized Bladder Cancer

Petros Grivas, MD, PhD, director, University of Washington Medicine’s Genitourinary Cancers Program, associate professor, oncology, University of Washington, Seattle Cancer Care Alliance, discusses the role of checkpoint inhibitors in the treatment of patients with localized bladder cancer.

It is an exciting time in this space, Grivas says. In the neoadjuvant setting, recent data suggests that a cisplatin-based regimen should be the frontline standard of care, but there are patients who may not be fit enough for this therapy; as such, there is an unmet need in these patients, says Grivas. Right now, these patients are going straight to surgery because there is no good evidence with carboplatin or other agents, adds.

To address this unmet need, checkpoint inhibitors are being tested in clinical trials with the endpoint of pathologic complete response (pCR) rates. For example, the ABACUS trial presented at the 2018 ASCO Annual Meeting evaluated the use of neoadjuvant atezolizumab (Tecentriq) in patients with locally advanced muscle invasive bladder cancer. In the study, 29% of patients achieved a pCR with the PD-L1 inhibitor followed by surgery. Similar encouraging data has been seen with pembrolizumab (Keytruda) administered at 3 doses.