MDACC 2018: Options for Patients Failing BCG Therapy

Houston, TX ( Dr. Ashish Kamat reviewed the emerging options that are currently under investigation for use in patients with non-muscle invasive bladder cancer who have failed BCG. Among these include novel formulations of mitomycin C (MMC), including MMC that is combined in a thermoreversible hydrogel, which is liquid when chilled and solidifies at body temperature. The formulation can serve as a sustained release over 6 hours.1 Nonbiodegradable devices, such as the TARIS system (TARIS Biomedical LLC, Lexington, MA), can potentially be positioned in the bladder and used to intravesically deliver drugs. Other studies have looked at heating MMC during bladder instillation (Combat Medical Ltd, Wheathampstead, Herts UK). Viral gene therapies such as rAd-IFNa/Syn3 (Instiladrin) have shown promising results in the phase 2 setting, with phase 3 data pending (NCT02773849). CG0070, an oncolytic adenovirus targeting the retinoblastoma pathway, has also shown efficacy in the phase 2 setting.2

Immunotherapy agents, such as the anti-PD-1 antibody pembrolizumab (NCT02625961) and anti-PD-L1 atezolizumab (NCT02844816), are also being investigated in these patients with follow-up ongoing. Of course, at the present time, radical cystectomy remains the standard of care. Dr. Kamat noted that for those who are cystectomy ineligible, an additional intravesical option currently available is sequential gemcitabine-docetaxel.3

Presented by: Ashish M. Kamat (@UroDocAsh), Professor of Urologic Oncology & Cancer Research, University of Texas MD Anderson Cancer Center, Houston, TX.

Written by Dr. Vikram M. Narayan (@VikramNarayan), Urologic Oncology Fellow and Ashish M. Kamat, MD (@UroDocAsh), Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX at the 13th Update on the Management of Genitourinary Malignancies, The University of Texas (MDACC - MD Anderson Cancer Center) November 9-10, 2018, Dan L. Duncan Building, Houston, TX

1. Lin JSJ, Kleinmann N, Wirth GJ, Matin SF, Mayer G, Nativ O, et al. Thermo reversible hydrogel based delivery of mitomycin C for treatment of upper tract urothelial carcinoma (UTUC). J Clin Oncol Conf. 2017
2. Packiam VT, Lamm DL, Barocas DA, Trainer A, Fand B, Davis RL, et al. An open label, single-arm, phase II multicenter study of the safety and efficacy of CG0070 oncolytic vector regimen in patients with BCG-unresponsive non-muscle-invasive bladder cancer: Interim results. Urol Oncol [Internet]. 2018;36(10):440–7. 
3. Steinberg RL, Thomas LJ, O’Donnell MA, Nepple KG. Sequential Intravesical Gemcitabine and Docetaxel for the Salvage Treatment of Non-Muscle Invasive Bladder Cancer. Bl Cancer [Internet]. 2015 Apr 30;1(1):65–72.

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