Geoffrey Sklar, MD, Chief Medical Officer, Chesapeake Urology Associates, discusses some of the challenges that come with conducting clinical trials in the treatment of patients with bladder cancer.

Most of the current trials in this space are in their infancy, explains Sklar. The problem is that it is very difficult to do uniform trials in bladder cancer, meaning getting patients together who are all at the same stage in their disease. Also, patients with advanced disease are usually older, in their 70s and 80s, and they may have more comorbidities than other individuals.

Sklar also touches on potential opportunities for infusion therapies to treat patients with kidney or bladder cancer. He notes that the side effect profiles of many immunotherapy agents are quite different from the intravenous chemotherapeutic agents. Thus, while infusion therapies, such as sipuleucel-T (Provenge), have proven to be beneficial in patients with prostate cancer, there are still unanswered questions about these treatments in bladder and kidney cancer.

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Dr. Sklar on Challenges With Clinical Trials in Bladder Cancer

Geoffrey Sklar, MD, Chief Medical Officer, Chesapeake Urology Associates, discusses the potential of immunotherapy agents in the treatment of patients with bladder cancer.

According to Sklar, the data for immunotherapy in bladder cancer show significant improvement over platinum-based chemotherapy, including cisplatin/gemcitabine, which represent the "gold standard" in this space.

Many of these patients have failed either neoadjuvant or adjuvant therapies, he says, but they are beginning to see more promising outcomes when treated with immunotherapy agents.

Looking ahead to the future, Sklar says that patients who have had very little or no hope thus far can likely see more benefits if they are treated with immunotherapy. The next steps should focus on determining which patients with bladder cancer are best suited to receive immunotherapy instead of chemotherapy, he explains.

Dr. Sklar on Immunotherapy Potential in Bladder Cancer

Geoffrey Sklar, MD, Chief Medical Officer, Chesapeake Urology Associates, discusses the role of nivolumab (Opdivo) in the treatment of patients with bladder cancer.

Currently, Sklar says, they are using the agent to treat advanced patients, specifically those who have had cystectomy with nodal disease or metastatic disease, and either failed therapy or are not candidates for frontline therapy. However, in the future, Sklar expects that they will be potentially looking at intravesical therapies with these drugs, which are not FDA approved at the present time, though the space for neoadjuvant therapy with these types of drugs is wide open.

According to Sklar, immunotherapy treatment in the non-muscle invasive population is of interest, as well. The question is whether the side effect profile is tolerable for patients with non-muscle invasive bladder cancer, and the answers will likely pan out over time. The potential exists right now, he says, but it remains to be seen which specific patient populations these agents will work best in.

Geoffrey Sklar, MD, Chief Medical Officer, Chesapeake Urology Associates, discusses the role of nivolumab in the treatment of patients with bladder cancer.

Dr. Sklar on the Role of Nivolumab in Bladder Cancer

Dr. Geoffrey Sklar, Chief Medical Officer, Chesapeake Urology Associates, spoke with 

 about some of the exciting advancements in bladder cancer during the LUGPA Annual Meeting.

The PD-L1 inhibitor drugs that have been approved for advanced bladder cancer are currently an exciting topic. A big question that remains is whether these can be effective in early disease as a neoadjuvant treatment, Sklar says.

Other areas, such as high-grade non-invasive bladder cancers, are currently an enigma, as there are not many treatments available. The goal is to see if there is a place for these diseases in that treatment paradigm, Sklar says.

Dr. Geoffrey Sklar, Chief Medical Officer, Chesapeake Urology Associates, spoke with OncLive about some of the exciting advancements in bladder cancer during the LUGPA Annual Meeting.

Geoffrey Sklar, MD

Articles

Dr. Sklar on Challenges With Clinical Trials in Bladder Cancer

Dr. Sklar on Immunotherapy Potential in Bladder Cancer

Dr. Sklar on the Role of Nivolumab in Bladder Cancer

Dr. Geoffrey Sklar On Immunotherapy Advancements in Bladder Cancer