Dr. Powles on Biomarkers for Immunotherapy in Bladder Cancer

Thomas Powles MBBS, MRCP, MD, professor of Genitourinary Oncology, lead, Solid Tumour Research, Barts Cancer Institute, director, Barts Cancer Centre, discusses biomarkers for immunotherapy in bladder cancer.

The frontline treatment of bladder cancer is evolving very quickly. Multiple immune checkpoint inhibitors have been approved for the first-line treatment of patients who are ineligible for cisplatin-based therapy. It is a step in the right direction, Powles says, but immune checkpoint inhibitors seem to lose response in large groups of patients, and are only active in about 1 in 5 patients. Chemotherapy helps most patients, whereas there is an entire population of patients who do not respond to immunotherapy, he added.

Recently, the FDA and EMA decided to change the frontline labels for checkpoint inhibitors in bladder cancer, restricting these agents to the biomarker-positive population. Powles says that this means there is a big problem with the biomarker-negative population. This raises a number of important issues, he adds, including the idea that checkpoint inhibitors will not supersede chemotherapy in randomized trials of unselected patients with bladder cancer. Biomarkers are going to be important in the future for selecting patients for trials of immunotherapy in bladder cancer.