Vignesh Packiam, MD, urologist, assistant professor of Urology, University of Iowa Hospitals and Clinics, discusses the adverse effects (AEs) associated with cabazitaxel and gemcitabine with pembrolizumab (Keytruda) in patients who are unresponsive to docetaxel with non-muscle invasive urothelial carcinoma.

Findings from a retrospective analysis showed 5 patients developed significant bladder toxicity with the regimen, though it may have been a result of their heavy treatment history with alternative therapies, Packiam says. Several patients had to have treatment with gemcitabine and cabazitaxel paused to allow their bladders to recover, Packiam explains. Moreover, 1 patient required a cystectomy due to end-stage bladder symptoms, Packiam adds.

The optimal dosing of cabazitaxel, gemcitabine, and pembrolizumab is still being explored, and the study has transitioned into a prospective protocol, where investigators will evaluate the optimal dosing regimen, Packiam concludes.

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Vignesh Packiam, MD, discusses the adverse effects associated with cabazitaxel and gemcitabine with pembrolizumab in patients who are unresponsive to docetaxel with non-muscle invasive urothelial carcinoma.


Dr. Packiam on Safety of Cabazitaxel/Gemcitabine Plus Pembrolizumab in Urothelial Carcinoma

Vignesh Packiam, MD, urologist, assistant professor of Urology, University of Iowa Hospitals and Clinics, discusses the investigation of cabazitaxel (Jevtana) and gemcitabine with pembrolizumab (Keytruda) in patients who are unresponsive to docetaxel with non-muscle invasive urothelial carcinoma.

Gemcitabine plus docetaxel has become a more common option as a sequential intravesical regimen for this patient population, Packiam says. Moreover, some of the patients in this population still experience recurrence after gemcitabine/docetaxel due to developed resistance to docetaxel, Packiam explains. Previous data indicated cabazitaxel can salvage a response in patients that were previously unresponsive, Packiam adds.

Single-agent pembrolizumab is FDA approved for patients with locally advanced or metastatic urothelial carcinoma who are not eligible for any platinum-containing chemotherapy, though there are some concerns about a suboptimal long-term response rate with this treatment, Packiam continues. In patients with more advanced, treatment-refractory disease, it is hypothesized that adding pembrolizumab to cabazitaxel plus gemcitabine could improve responses and their duration, Packiam concludes.

Vignesh Packiam, MD, discusses the investigation of cabazitaxel and gemcitabine with pembrolizumab in patients who are unresponsive to docetaxel with non-muscle invasive urothelial carcinoma.


Vignesh Packiam, MD

Articles

Dr. Packiam on Safety of Cabazitaxel/Gemcitabine Plus Pembrolizumab in Urothelial Carcinoma

Dr. Packiam the Investigation of Cabazitaxel Plus Gemcitabine with Pembrolizumab in Urothelial Carcinoma