Dr. Grivas on Immunotherapy in Advanced Urothelial 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 use of immunotherapy in patients with advanced urothelial cancer.

There is much excitement surrounding the advent of immune checkpoint inhibitors, says Grivas. Many of the approvals in urothelial cancer were based on single-arm phase II trials. There have been 2 randomized phase III trials trying to evaluate the role of immune checkpoint inhibitors, such as pembrolizumab (Keytruda) versus single-agent taxane—docetaxel or paclitaxel—in the United States.

The trial met the primary endpoint of overall survival (OS) benefit with pembrolizumab as a salvage therapy versus chemotherapy in patients with platinum-refractory advanced urothelial cancer, says Grivas. The median OS difference was about 3 months, favoring pembrolizumab in all-comers.

Based on the assay that was used, patients with higher PD-L1 expression still showed benefit with pembrolizumab. This provided level 1 evidence for the use of pembrolizumab in patients with platinum-refractory advanced urothelial cancer. That agent has the highest level of evidence in the salvage setting in patients who progress on or after platinum-based chemotherapy, Grivas says.