Petros Grivas, MD, PhD, presented “Neoadjuvant Immune-Checkpoint Inhibition for Muscle-Invasive Bladder Cancer (MIBC)” during the Perspectives in Urology: Point Counterpoint 2020 virtual conference in November 2020.

How to cite: Grivas, Petros. “Neoadjuvant Immune-Checkpoint Inhibition for Muscle-Invasive Bladder Cancer” November 2020. Accessed Apr 2021. https://grandroundsinurology.com/neoadjuvant-immune-checkpoint-inhibition-for-muscle-invasive-bladder-cancer/

Neoadjuvant Immune-Checkpoint Inhibition for Muscle-Invasive Bladder Cancer (MIBC) – Summary

Petros Grivas, MD, PhD, Associate Professor of Oncology at the University of Washington School of Medicine in Seattle, argues for the use of immune-checkpoint inhibition over cisplatin-based chemotherapy for muscle-invasive bladder cancer (MIBC) based on promising level 1 evidence. He begins with an overview of the PURE-01 trial, which found that single-agent pembrolizumab safely achieved a pTO of 42% and a down-staging rate of 54%. Dr. Grivas continues by discussing the possibility of imaging endpoint use, reaching the conclusion that more validation is necessary before progress can be made in this area. He then returns to the PURE-01 trial, reviewing the surgical safety data  which demonstrate high-grade complications post-pembrolizumab in 34% of patients, a significant minority. Dr. Grivas follows this by looking at the wider landscape of phase 2 trials in MIBC beyond just PURE-01, noting that they have shown promising pathologic complete response rates and rates of pathologic downstaging to non-muscle invasive disease. He looks to the future, suggesting that with more data and validation physicians will be able to treat patients based on their individual biology. Dr. Grivas concludes by arguing that it may be possible to use immune-checkpoint inhibition in patients who are unfit for cisplatin or to even avoid using cisplatin altogether, but notes that there is a need for more high-quality studies to inform discussions.

The cisplatin-based chemotherapy perspective of this point-counterpoint series will be published next week on GRU.

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.