Dr. Talwar on the Utility of Immunotherapy in Metastatic Urothelial Carcinoma

Vineet Talwar, DM, FRCP, DNB, FICP, FIMSA, MNAMS, director, Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, discusses the utility of immunotherapy in metastatic urothelial carcinoma.

Data from key studies in urothelial carcinoma suggest that patients with high PD-L1 expression are more likely to benefit from immunotherapy compared with patients with no or low PD-L1 expression, Talwar says. However, PD-L1 is not thought to be a robust biomarker for response in urothelial cancer based on findings from the phase 3 IMvigor211 trial (NCT02807636), in which atezolizumab (Tecentriq) failed to improve overall survival compared with chemotherapy in patients with PD-L1–overexpressing urothelial carcinoma, says Talwar.

Despite these findings, it appears that PD-L1 expression and tumor mutational burden (TMB) are synergistic, meaning patients with high PD-L1 expression and high TMB should respond to immunotherapy, concludes Talwar.