"Expert Discusses Evolving Frontline Treatment Landscape for Bladder Cancer" -Angelica Welch
The FDA released a drug safety notification in May 2018, warning against the use of frontline single-agent immune checkpoint inhibition for patients with urothelial carcinoma considered biomarker-negative, which are those with PD-L1–low expressing platinum-eligible disease. The European Medicines Agency (EMA) issued a similar warning, both following data demonstrating lower overall survival with pembrolizumab (Keytruda) and atezolizumab (Tecentriq) versus platinum-based chemotherapy in these patients.Due to these developments, there is a renewed need to investigate biomarkers and combinations with chemotherapy and targeted agents. There is some work by Matthew Galsky, MD, of Mount Sinai Hospital, looking at the stromal signature in urothelial cancer. Although tumor mutational burden (TMB) and PD-L1 expression are high and there is T-cell infiltration, there may be inhibitory stromal signatures that might be the reason why the drugs are not as active as we thought they might be. They certainly are not as active as they are in lung cancer, where we now have immune combination therapy, chemotherapy combinations, and single-agent therapy for patients.
— Matthew Galsky, MD, Director, Genitourinary Medical Oncology, Tisch Cancer Institute, Professor, Medicine, Hematology and Medical Oncology, Urology, Icahn School of Medicine at Mount Sinai
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