ASCO GU 2017: Optimizing Outcomes in Muscle-Invasive and Metastatic Bladder Cancer - Medical Oncologist’s Perspective - Session Highlights
Orlando, Florida USA (UroToday.com) Jonathan Rosenberg, Memorial Sloan Kettering, discussed chemotherapy. There is no role for carboplatin and cisplatin based regimens should be utilized. Pathological downstaging is associated with high cure rate with pT2 having overall survival in the Memorial Sloan series at 90% v37%, respectively. There is no difference in outcomes between GC v MVAC with findings suggesting varying side effect profiles favoring GC. There are many selected neoadjuvant bladder immunotherapy trials including atezolizumab and pembrolizumab either alone or in combination with cisplatin based regimens. Adjuvant chemotherapy is characterized by poor accrual and results are difficult to discern benefit with trends towards improved survival outcomes in meta-analyses and large population-based studies. At the present time, if considering adjuvant therapy the recommendation would be patient enrollment in ongoing adjuvant immunotherapy trials with nivolumab or atezolizumab or pembrolizumab or observation. Immune checkpoint blockade has emerged in the treatment for metastatic urothelial carcinoma. KEYNOTE-045 randomized patients with prior cisplatin based chemotherapy treated with pembrolizumab with noted improved overall survival among these patients.
Presenter: Jonathan Rosenberg, Memorial Sloan Kettering
Contributed by Stephen B. Williams, MD, Assistant Professor, Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX and Ashish M. Kamat, MD, Professor, Department of Urology, The University of Texas MD Anderson, Houston, TX
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