Dr. Grivas on Combination Strategies in Genitourinary 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 combination strategies in genitourinary cancer.

Immunotherapy can be combined with chemotherapy and antiangiogenesis agents, explains Grivas. There are trials with atezolizumab (Tecentriq) and bevacizumab (Avastin) in kidney cancer in addition to data with cabozantinib (Cabometyx) and immunotherapy. Additionally, physicians are looking at combining checkpoint inhibitors that target different parts of the immune system, adds Grivas. It is not yet known whether this combination with CTLA-4 or other targets will induce better responses with PD-1/PD-L1 inhibitors.

Physicians also have vaccines, which are a very promising way to try to prime the immune system for a later checkpoint inhibitor, explains Grivas. This is being explored in patients with advanced urothelial cancers. There is also an ongoing umbrella trial with different targeted therapies that are utilizing genomic sequencing. Grivas explains that once the target is identified through genomic sequencing, a targeted therapy is paired with immunotherapy to get a synergistic approach. Additionally, the combination of antibody-drug conjugates with checkpoint inhibition is also a potential path forward. Finally, radiation therapy may release neoantigens based on immunogenic cell death.