ASCO GU 2017: Urothelial Carcinoma: Year in Review - Session Highlights

Orlando, Florida USA ( Matthew Milowsky, University of North Carolina, presented the year in review in bladder cancer. Immuno-oncology developments include the IMVigor, Checkmate and KEYNOTE are to name a few. Prior to 2016 there were no agents studied in cisplatin refractory disease. IMVigor 210 assessed use of atezolumab with overall response rate at 10% with 86% of complete response ongoing.

The median survival was 8mo which was higher among PDL-1 + v negative patients. Checkmate 275 assessed nivolumab showed durability of responses with ongoing time to response at 2mo. Overall survival was significantly improved with higher levels associated with PDL-1 expression. KEYNOTE-045 randomized metastatic patients to pembrolizumab or cisplatin based regimens with improved survival benefit (10 v 7 mo, p<0.002) among those randomized to pembrolizumab. Checkmate 032 assessed nivolumab with or without ipilimumab in metastatic patients with improved survival 10 v 7 mo. IMVigor 210 cohort 1 without prior chemotherapy received atezolizumab ORR 24% regardless of PDL-1 response. Further trials underway assessing the front-line targeted therapy in no-muscle and muscle-invasive disease are underway.

Efficacy BGJ398 according to FGFR3 were assessed which showed ORR 13% and disease control in 22%. Afatinib in cisplatin-refractory disease according to ERBB alterations not improved PFS 6.6 v 1.4 months according to alterations. Predictive biomarkers for platinum response are being explored including ERCC2 alterations. Dr. Plimack’s work and development of a 3 gene signature predicted pathologic response to cisplatin based chemotherapy. DNA Damage Response (DDR) correlated alterations to response to chemotherapy. 26% harbored deleterious DDR alterations with significant survival difference according to gene alteration. Comparative effectiveness research from the National Cancer Database supports the continued use of chemotherapy in the treatment of patients undergoing radical cystectomy (neoadjuvant or adjuvant).

Presenter: Matthew Milowsky, University of North Carolina

Written By: Stephen B. Williams, MD, Assistant Professor, The University of Texas Medical Branch at Galveston, Galveston, TX and Ashish M. Kamat, MD, Professor, The University of Texas MD Anderson, Houston, TX

at the 2017 Genitourinary Cancers Symposium - February 16 - 18, 2017 – Orlando, Florida USA