Buenos Aires, Argentina (UroToday.com) Peter Goebell, Professor University of Erlangen, presented a comprehensive review of systemic agents in bladder cancer. Neoadjuvant chemotherapy (NAC) has modest survival benefit (5% overall survival benefit in meta-analysis) versus no NAC.
Adjuvant therapy has similar benefit, however, patients may be unable to undergo therapy in the adjuvant setting. New immunotherapy data has surged in recent years including anti PDL-1, anti PD-1 and anti CTLA4 inhibitors. Rather than treating the disease we have shifted to treating the host to provoke an immune response to kill cancer cells. Atezolizumab has been shown to improve survival in bladder cancer patients refractory to conventional chemotherapy. Pembrolizumab has had similar outcomes. Durvalumab has shown fast and durable tumor shrinkage inherent to the other PDL-1 inhibitors as well. Nivolumab has confirmed overall survival benefit dependent on PDL-1 expression (increased expression has improved survival) in patients with metastatic bladder cancer previously treated with platinum based chemotherapy. Side effects are similar to other immunotherapy agents with rare high grade side effects observed >2% in treated patients. Atezolizumab has shown increased overall survival and up to 9% complete response rate in cisplatin-ineligible metastatic bladder cancer patients and may be a new standard in these patients (in addition to prior chemotherapy treated patients). This is an exciting time in bladder cancer systemic therapy and further research discerning treatment in patients at earlier disease stage and/or in combination with other therapies are being explored.
World Urological Oncology Federation Symposium at the SIU Congress 2016 - October 20 - 23, 2016 – Buenos Aires, Argentina
Written By: Stephen B. Williams, M.D., Assistant Professor in Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.