Peter Black, MD, senior research scientist, Vancouver Prostate Centre, associate professor, Department of Urologic Sciences, University of British Columbia, discusses future developments being made in the field of immunotherapy for patients with bladder cancer.  

Immunotherapy still holds the majority of interest in bladder cancer, but there is more to treatments than just immunotherapy, states Black.   

The clinical trial field has become very complex as things move upstream, explains Black. There are adjuvant trials before and after radical cystectomy, and trials in non-muscle invasive bladder cancer.   

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Peter Black, MD, senior research scientist, Vancouver Prostate Centre, associate professor, Department of Urologic Sciences, University of British Columbia, discusses future developments being made in the field of immunotherapy for patients with bladder cancer.

Dr. Black on the Developments in the Field of Immunotherapy for Bladder Cancer

Peter Black, MD, senior research scientist, Vancouver Prostate Centre, associate professor, Department of Urologic Sciences, University of British Columbia, discusses selecting immunotherapy agents in bladder cancer.

Right now, there is not a clear-cut option for immunotherapy in the treatment of bladder cancer. It is currently up to treating physicians’ preference.

Every other day there are new data, says Black, and the community is just going to have to wait until the dust settles for a definitive answer.

Dr. Black on Selecting Immunotherapy Agents in Bladder Cancer

Peter Black, MD, senior research scientist, Vancouver Prostate Centre, associate professor, Department of Urologic Sciences, University of British Columbia, discusses biomarker development in bladder cancer.

Since only 20% to 25% of patients have an objective response, developing biomarkers is important to determine which treatments a patient should receive, explains Black. PD-L1 is a current biomarker in development, but currently has no utility in bladder cancer, states Black. Additionally, peripheral immune cells and sequencing T-cell receptors are also in development.

Dr. Black on Biomarkers for Immunotherapy in Bladder Cancer

Peter Black, MD, senior research scientist, Vancouver Prostate Centre, associate professor, Department of Urologic Sciences, University of British Columbia, discusses immunotherapy biomarkers in bladder cancer.

Investigators are actively investigating biomarkers in bladder cancer. Black says that only about 20% to 25% of patients achieve an objective response to immunotherapy. Moreover, the drugs are expensive and potentially toxic, so it is important to select the right types of patients for them.

The easiest biomarker is PD-L1 immunohistochemistry, but currently has no utility in patients with bladder cancer, Black says.

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Dr. Black Discusses Immunotherapy Biomarkers in Bladder Cancer

Peter Black, MD, senior research scientist, Vancouver Prostate Center, associate professor, Department of Urologic Sciences, University of British Columbia, discusses the impact of durvalumab (Imfinzi) in bladder cancer.

Durvalumab is approved for use in patients with locally advanced or metastatic bladder cancer who have disease progression during or following platinum-containing chemotherapy, or who have disease progression within 12 months of neoadjuvant or adjuvant treatment with platinum-containing chemotherapy.

In addition to treating patients, durvalumab has brought a lot of industry and research interest to bladder cancer, says Black.

Dr. Black Discusses the Impact of Durvalumab in Bladder Cancer

Peter Black, MD, senior research scientist, Vancouver Prostate Center, associate professor, Department of Urologic Sciences, University of British Columbia, discusses sequencing of immunotherapy for patients with bladder cancer.

Bladder cancer now has many different therapies which has made the sequencing of treatments a question that needs to be answered, explains Black.

Currently, patients with metastatic bladder cancer would receive chemotherapy and then a checkpoint inhibitor, such as durvalumab (Imfinzi). If patients are cisplatin ineligible, atezolizumab (Tecentriq) is approved in that setting, states Black.

Dr. Black on Sequencing of Immunotherapy in Bladder Cancer

Peter Black, MD, senior research scientist, Vancouver Prostate Center, associate professor, Department of Urologic Sciences, University of British Columbia, discusses combination trials with durvalumab (Imfinzi) for patients with bladder cancer.

Durvalumab works as a monotherapy for the second-line setting after cisplatin therapy, explains Black. In the first-line setting there is a combination trial of durvalumab versus durvalumab plus tremelimumab versus standard chemotherapy.

In other disease sites, the combination works well—making people very optimistic but the results will take a few years, states Black.

Peter Black, MD