Michael Devitt, MD, a hematologist and oncologist, as well as an assistant professor at the University of Virginia Medical Center, discusses utilizing PD-L1 status in biomarker-guided therapies for patients with bladder cancer.

Currently, the 2 biomarkers that are often used in clinical practice for this patient population are PD-L1 and 

, Devitt says. PD-L1 can be utilized in patients who are cisplatin ineligible in the frontline setting to help determine whether they are better suited to receive carboplatin-based chemotherapy or immunotherapy, Devitt explains.

For patients who have either low or no expression of PD-L1, response rates to PD-1 inhibitors are low. Moreover, they are much less likely to benefit from frontline immunotherapy, Devitt notes. As such, a chemotherapy regimen of carboplatin and gemcitabine could be a better option for this patient population, Devitt concludes.

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Michael Devitt, MD, discusses utilizing PD-L1 status in biomarker-guided therapies for patients with bladder cancer.


Dr. Devitt on Utilizing PD-L1 in Biomarker-Guided Therapies in Bladder Cancer

Michael Devitt, MD, a hematologist and oncologist and an assistant professor at the University of Virginia Medical Center, discusses the 

recent withdrawals of immunotherapy agents used to treat patients with bladder cancer

An issue with immunotherapy agents that have had their indications voluntarily withdrawn in the bladder cancer paradigm is that they were approved only based on phase 2 clinical trial data, and the phase 3 confirmatory data did not prove to be as promising, Devitt says. However, the agents Devitt uses most in practice, namely pembrolizumab (Keytruda) and atezolizumab (Tecentriq), still have efficacy data that hold up, according to Devitt. For example, second-line pembrolizumab has randomized phase 3 data that support the efficacy of the agent. It is unlikely that immunotherapy options will be removed from the paradigm entirely, Devitt adds.

The withdrawal of some of these agents may also be an economic-driven decision made by some of the pharmaceutical companies, Devitt explains. Many oncologists are familiar with these agents from other indications, and drugs that have been withdrawn may have had a harder time developing a market share, even if they do demonstrate efficacy, Devitt says.

Although it is important to remember and consider negative phase 3 data, immunotherapy still has a place in the bladder cancer treatment paradigm, Devitt concludes.

Michael Devitt, MD, discusses the recent withdrawals of immunotherapy agents used to treat patients with bladder cancer.

Michael Devitt, MD

Articles

Dr. Devitt on Utilizing PD-L1 in Biomarker-Guided Therapies in Bladder Cancer

Dr. Devitt on the Impact of Withdrawn Immunotherapy Agents in Bladder Cancer