Dr Jayram on the Role of Immunotherapy in Bladder Cancer

Gautam Jayram, MD, codirector, Advanced Therapeutics Center, Urology Associates of Nashville, discusses the current indications for immunotherapy agents in the bladder cancer treatment paradigm, as well as immune-related adverse effects (AEs) to be aware of when treating patients who are receiving these therapies, which he discussed in a presentation at the 2023 LUGPA Annual Meeting.

In January 2020, the FDA approved pembrolizumab (Keytruda) for patients with Bacillus Calmette-Guerin–unresponsive, high-risk, non–muscle-invasive bladder cancer (NMIBC) with carcinoma in situ with or without papillary tumors who are not eligible for or have chosen not to undergo cystectomy. Urologists should consider treatment with pembrolizumab for eligible patients with NMIBC, Jayram says. Immunotherapy agents may also benefit patients in the adjuvant setting post-cystectomy, particularly those who are at high risk of disease recurrence, Jayram explains. Furthermore, novel data indicate that immunotherapy may play a role in the frontline treatment of patients with metastatic bladder cancer, eliminating the need for chemotherapy in this setting, Jayram emphasizes

Immunotherapy agents are newer additions to the urology field, and they differ from conventional strategies that urologists are accustomed to using, according to Jayram. Structured bladder cancer programs can help urologists monitor and manage immune-related AEs, and many patients may benefit from these programs, Jayram notes. However, even without the implementation of bladder cancer programs, urologists should still be aware of the AE profiles of the immunotherapy agents used for patients with bladder cancer, as many patients receive these therapies, Jayram says.

Immunotherapy agents generate inflammation in all organ systems, and they are commonly associated with AEs such as rash, diarrhea, and cough, Jayram explains, adding that more severe AEs can also develop over time. Although these AEs are common, they should not deter urologists from administering immunotherapy agents, Jayram emphasizes. Instead, urologists and their entire multidisciplinary teams should learn about these agents, monitor for AEs, and discuss the potential for toxicities with patients, Jayram concludes.