Daniel P. Petrylak, MD, presented “Management of BCG-Unresponsive Cystectomy-Ineligible Bladder Cancer Patients: Pembrolizumab” virtually during the Perspectives in Urology: Point Counterpoint 2020 virtual conference in November 2020.
How to cite: Petrylak, Daniel P. “Management of BCG-Unresponsive Cystectomy-Ineligible Bladder Cancer Patients: Pembrolizumab.” November 2020. Accessed Jul 2024. https://grandroundsinurology.com/management-of-bcg-unresponsive-cystectomy-ineligible-bladder-cancer-patients/
Management of BCG-Unresponsive Cystectomy-Ineligible Bladder Cancer Patients: Pembrolizumab – Summary
Daniel P. Petrylak, MD, Director of Genitourinary Oncology, Professor of Medicine and Urology, Co-Leader of Cancer Signaling Networks, and Co-Director of the Signal Transduction Program at Yale University Cancer Center in New Haven, Connecticut, discusses alternatives to bacillus Calmette-Guerin (BCG) immunotherapy for non-muscle invasive bladder cancer (NMIBC), focusing on pembrolizumab. Dr. Petrylak gives an overview of NMIBC and of NMIBC management with BCG immunotherapy. He explains that BCG immunotherapy is standard of care for this difficult-to-treat disease state and has proven capable of reducing recurrence, progression, and death rates, but that there is a subset of patients who experience BCG failure. Dr. Petrylak describes the different kinds of BCG failure, including BCG-relapsing, BCG-intolerant, BCG-refractory, and BCG-resistant disease, and then discusses the limited treatments currently available for these patients. He observes that intravesical chemotherapies have not proven highly efficacious for NMIBC, but that immune checkpoint inhibitors like pembrolizumab show significant promise. Dr. Petrylak reviews the KEYNOTE-057 trial, which found that immune checkpoint therapy with pembrolizumab can lead to complete responses in 40% of patients, and the SWOG S1605 trial, which did not reach its endpoint but found a complete response to immune checkpoint therapy with atezolizumab at 6 months in 27% of patients. He concludes by discussing other ongoing and future trials to further evaluate checkpoint inhibitors for NMIBC.
About the Perspectives in Urology: Point Counterpoint 2020 virtual conference:
Presented by Program Chair and Grand Rounds in Urology Editor-in-Chief E. David Crawford, MD, as well as Program Co-Chair Dan Theodorescu, MD, PhD, this virtual conference brought together leading experts in urology, medical oncology, and radiation oncology to discuss and debate the latest topics in genitourinary cancers, primarily prostate cancer and bladder cancer. This two-day interactive conference offered topical lectures, pro/con debates, interesting-case presentations, interactive panel discussions, and interactive audience and faculty networking. A focus on prostate cancer was given on Wednesday, November 11th, with a focus on bladder cancer given on Thursday, November 12th.
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.
