Dr. Grivas on Immunotherapy in Platinum-Refractory Metastatic Bladder Cancer

Petros Grivas, MD, PhD, director of Genitourinary Cancers Program and associate professor of Oncology, University of Washington, medical oncologist, Seattle Cancer Care Alliance, discusses the use of immunotherapy in patients with metastatic platinum-refractory bladder cancer.

In platinum-refractory disease, there are 5 FDA-approved checkpoint inhibitors available. However, only pembrolizumab (Keytruda) has Level I evidence per National Comprehensive Cancer Network guidelines since it met the primary endpoint of a phase III randomized clinical trial. The other 4 inhibitors are atezolizumab (Tecentriq), nivolumab (Opdivo), durvalumab (Imfinzi), and avelumab (Bavencio), says Grivas. In light of these approvals, there is a great opportunity to try to improve upon single-agent checkpoint inhibition, as well as combination therapies.

Antibody-drug conjugates such as enfortumab vedotin and sacituzumab govitecan are also being explored in this setting, explains Grivas. Moreover, targeted therapies with FGFR inhibitors, PARP inhibitors, and HER2 inhibitors are also being tested in clinical trials. The data with FGFR inhibitors look very promising, says Grivas. Targeted therapies have a future in this space based on proper patient selection; that's where next-generation sequencing plays an important role with tumor tissue, he adds. Circulating tumor DNA may become another tool to profile patients’ cancers that could ultimately be used to design and conduct innovative clinical trials, he concludes.