Professor, Clinical Research Division, Fred Hutch, Clinical Director, Genitourinary Cancers Program, Fred Hutch

Petros Grivas MD, PhD, director, University of Washington Medicine’s Genitourinary Cancers Program, associate professor, Oncology, University of Washington, Seattle Cancer Care Alliance, discusses emerging biomarkers in advanced urothelial cancer.

Physicians have developing data regarding emerging biomarkers in advanced urothelial cancer. In May 2018, the FDA released a statement commenting on the potential role of PD-L1 immunohistochemistry testing to predict whether patients would respond better or worse to immune checkpoint inhibitors. Predicting response to therapy based on PD-L1 expression is not part of clinical practice, says Grivas.

It may become another debate whether physicians consider that biomarker expression further. For the time being, Grivas says it is not a companion diagnostic. It is, however, something to look for alongside tumor mutational burden, gene expression profiling and subtypes, DNA damage response to mutations, and circulating tumor DNA. These will be examined in prospective clinical trials to evaluate their clinical utility, says Grivas.

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Petros Grivas MD, PhD, director, University of Washington Medicine’s Genitourinary Cancers Program , associate professor, Oncology, University of Washington, Seattle Cancer Care Alliance, discusses emerging biomarkers in advanced urothelial cancer.

Dr. Grivas on Emerging Biomarkers in Urothelial Cancer

Petros Grivas, MD, PhD, medical oncologist, Cleveland Clinic, discusses next steps for immunotherapy for the treatment of patients with bladder cancer.

According to Grivas, this is a great environment because there are many ongoing clinical trials. There are close to 1000 clinical trials across tumor types evaluating different combinations of immunotherapy

Dr. Grivas on the Next Steps for Immunotherapy in Bladder Cancer

Petros Grivas, MD, PhD, medical oncologist, Cleveland Clinic, discusses combining chemotherapy and immunotherapy as a treatment approach for patients with bladder cancer.

Chemotherapy alone has the potential to induce changes in a tumor microenvironment. Cleveland Clinic data indicated there was variability in PD-L1 and PD-L2 expression after neoadjuvant chemotherapy in patients. Some patients had a lower PD-L1/PD-L2 expression at the cystectomy specimens compared with the transurethral resection of bladder tumor specimens. Those who experienced increased or stable PD-L1 expression had earlier recurrence.

The combination of chemotherapy with immunotherapy may have synergistic results, says Grivas. There is also the theoretical concept of immunogenic cell death that needs to be further evaluated in clinical practice, explains Grivas.

Petros Grivas MD, PhD

Articles

Dr. Grivas on Emerging Biomarkers in Urothelial Cancer

Dr. Grivas on the Next Steps for Immunotherapy in Bladder Cancer

Dr. Grivas on Combining Chemotherapy and Immunotherapy in Bladder Cancer