Daniel P. Petrylak, MD, presented “Bladder Cancer and Immunotherapy” during the 3rd Annual International Bladder Cancer Update on January 23, 2019 in Beaver Creek, Colorado.
How to cite: Petrylak, Daniel P. “Bladder Cancer and Immunotherapy” January 23, 2019. Accessed Jul 2024. https://grandroundsinurology.com/bladder-cancer-immunotherapy/
Bladder Cancer and Immunotherapy- Summary:
Daniel P. Petrylak, MD, reviews data regarding currently-approved immunotherapy agents for bladder cancer in first- and second-line settings. He advocates for future research regarding immunotherapy-based combinations, as well as investigating immunotherapy in earlier stages of the disease.
Abstract:
Immunotherapy has emerged as a promising treatment option for patients with bladder cancer. Of the five currently-approved checkpoint inhibitors for urothelial carcinoma (UC), atezolizumab and pembrolizumab have approval in the first-line, cisplatin-ineligible setting, as well as in the platinum-pretreated patients. Nivolumab, durvalumab, and avelumab only have approval for platinum-pretreated patients.
Patient selection for first-line checkpoint inhibition therapy remains a challenge due to inconsistencies in the definition of medically unfit patients. Nonetheless, the treatment goals for these patients has shifted towards palliation of symptoms rather than survival or therapy response. This presentation reviews findings from IMvigor210 (Cohort 1) and KEYNOTE-052 trials as they pertain to checkpoint inhibitors as first-line therapy for cisplatin-ineligible patients.
Results from these trials led to the exploration of potentially moving checkpoint inhibitors to the front-line cisplatin-eligible patients, as well as a restructuring of therapy sequencing for cisplatin-ineligible patients. This presentation analyzes recent data on response rates to checkpoint inhibition in patients with PD-L1 low status, as well as first-line chemotherapy/checkpoint inhibition combination in metastatic UC.
Future research on this topic should focus on the possibility of immunotherapy for non-muscle invasive disease, investigating further therapy combinations, and developing of biomarkers beyond PD-L. Additionally, physicians should maintain a thorough understanding of the markers of resistance and response, as this will help when designing future trials in earlier disease.
About the International Bladder Cancer Update
The International Bladder Cancer Update (IBCU) is an annual one-day CME conference focused on bladder cancer treatment updates. IBCU takes place during its sister conference, the International Prostate Cancer Update (IPCU). The conference’s faculty consists of international experts, and the event caters to urologists, urologic oncologists, and other healthcare professionals. In addition to didactic lectures, IBCU features interactive discussions, a panel roundtable, debates, and case presentations. Dr. Petrylak presented this lecture during the 3rd IBCU in 2019. Please visit this page in order to learn more about future IBCU meetings.
ABOUT THE AUTHOR
Daniel P. Petrylak, MD, leads the genitourinary cancers medical oncology team at Smilow Cancer Hospital as director of the genitourinary cancer research group, professor, and co-director of the Cancer Signaling Network program. Dr. Petrylak joined Yale from Herbert Irving Cancer Center at Columbia University Medical Center with New York-Presbyterian Hospital, where he served as Professor of Medicine (Medical Oncology) and Urology and began his appointment in September of 2012. Dr. Petrylak is a member of the American Association for Cancer Research (AACR), American Society for Clinical Oncology (ASCO), American College of Physicians (ACP), American Association for the Advancement of Science (AAAS), American Urological Association (AUA), and the Southwest Oncology Group (SWOG). After serving for more than 20 years as the advanced bladder chair for SWOG, Dr. Petrylak is now the Vice Chair of the Genitourinary Committee. He additionally has led multiple national and international studies in prostate and bladder cancer.
Dr. Petrylak’s research interests span both prostate and bladder cancer. He led an investigator-initiated trial of docetaxel and estramustine in castration resistant prostate cancer. The results of this study supported a phase 3 trial of this combination in SWOG led by Dr. Petrylak, which in turn, supported the FDA approval of docetaxel for castration resistant prostate cancer. This was one of the first two trials to demonstrate a survival benefit in this state of disease. Dr. Petrylak has also been instrumental in the development of immunotherapy and targeted therapies for refractory bladder cancer. His work with Enfortumab Vedotin has supported the accelerated and full FDA approval of this drug.
Dr. Petrylak received his undergraduate degree from Columbia College and his medical degree from Case Western University School of Medicine. He completed his internship and residency at Albert Einstein College of Medicine and his fellowship in medical oncology at Memorial Sloan-Kettering Cancer Center. He has authored more than 200 peer-reviewed articles and book chapters on prostate and bladder cancer research outcomes.
