Updates on Immunotherapy for Bladder Cancer

Posted by Daniel P. Petrylak, MD | Oct 2018

Daniel P. Petrylak, MD, presented “Updates on Immunotherapy for Bladder Cancer” during the 19th Annual Future Directions in Urology Symposium on August 11, 2018 in Colorado Springs, Colorado.

How to cite: Petrylak, Daniel P.. “Updates on Immunotherapy for Bladder Cancer” August 11, 2018. Accessed [date today]. https://grandroundsinurology.com/updates-on-immunotherapy-for-bladder-cancer/

Updates on Immunotherapy for Bladder Cancer – Summary:

Daniel P. Petrylak, MD, discusses new treatments for metastatic bladder cancer and the importance of accurate PD-L1 markers. He also offers his predictions for bladder cancer checkpoint inhibitor therapy and second-line agents for patients who do not respond to checkpoint inhibitors.

Updates on Atezolizumab and Pembrolizumab

The FDA has approved atezolizumab and pembrolizumab for frontline therapy in platinum ineligible patients, but recently issued a warning against using these drugs in patients who do not express PD-L1. Because of this warning, it is important to assess the PD-L1 status of patients, which requires also assessing the accuracy of biomarker assays for PD-L1.

Prognostic Factors for Metastatic Urothelial Carcinoma (mUC)

PD-L1 may also be predictive and prognostic for patients with mUC. Urologists are currently considering including mutational burden as a prognostic factor of mUC and response to checkpoint inhibition therapy.

The Future of Checkpoint Inhibition Therapy in Bladder Cancer

Dr. Petrylak predicts that, in the future, urologists will use checkpoint inhibition therapy with either a gemcitabine/cisplatin or cisplatin/carboplatin combination as frontline therapy. If this shift occurs, the second line therapy space will open for other agents.

Emerging Agents

An example of other agents for advanced or mUC is enfortumab vedotin, an antibody drug conjugate that demonstrates activity in patients who failed checkpoint inhibitor therapy or patients with liver metastases. Enfortumab vedotin may be a possible second-line therapy in the future.

A large phase II trial completed looking at enfortumab vedotin as second-line therapy, and aims to get the agent accelerated approval for mUC. Additionally, the randomized trial EV-301 will compare enfortumab vedotin to chemotherapy.

IME-132 is also a drug in this class with breakthrough status under evaluation in this setting.

About Dr. Petrylak

Dr. Petrylak is the head of the advanced bladder cancer Southwest Oncology Group (SWOG) Genitourinary Committee and is involved in clinical trials research on an international level. Due to this experience, he has extensive knowledge in bladder cancer, mUC, and specific drugs for this disease state and their approvals.

About the Future Directions in Urology Symposium

The Future Directions in Urology Symposium (FDUS) is an annual collaborative meeting with a faculty consisting of the top researchers, physicians, and educators in the field of urology. During FDUS, experts provide updates on recent developments and debate innovative management approaches in genitourinary cancers and urologic conditions. Subsequently, the experts devise consensus statements in accordance with the discussions held in the meeting.

In this video, Dr. Petrylak discloses the thesis of the discussion he led during FDUS.

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About The Author

Daniel P. Petrylak, MD

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.

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