Dr. O'Donnell on the Evolution of Immunotherapy in Metastatic Bladder Cancer

Peter O’Donnell, MD, associate professor of medicine, University of Chicago Medicine, discusses the evolution of immunotherapy in metastatic bladder cancer.

When immunotherapy first came to market in advanced bladder cancer, it was approved for patients in the platinum-refractory setting. Since then, it has transitioned to the frontline setting. In May, the FDA announced that immunotherapy should be used sparingly in the frontline setting, especially if a patient has yet to receive platinum-based chemotherapy, notes O’Donnell. Cisplatin-based therapy is still the gold standard in that frontline setting, states O’Donnell.

Based on the FDA announcement, patients who are cisplatin-ineligible should receive gemcitabine and carboplatin rather than immunotherapy monotherapy unless physicians know that that patient is PD-L1—positive. As a result, physicians are doing PD-L1 testing in the frontline setting to try to identify those patients where immunotherapy might be an option. For patients who are not eligible for chemotherapy, the new FDA guidance states that they are eligible to receive immunotherapy as opposed to no treatment at all, adds O’Donnell.