Dr. Bellmunt Highlights Immunotherapy Options in Bladder Cancer

Joaquim Bellmunt, MD, PhD, genitourinary oncologist, Beth Israel Deaconess Medical Center, associate professor of medicine, Harvard Medical School, differentiates between immunotherapy options available for the treatment of patients with in bladder cancer.

In the span of a year, 7 immunotherapy agents have received FDA approval in various settings for the treatment of patients with bladder cancer. However, the approvals were based mainly on durable responses seen in phase I and II trials, says Bellmunt. Without any head-to-head comparisons, deciding which agent is the strongest option for patients remains a challenge.

The only phase III trial that has shown a clear survival advantage in this space is KEYNOTE-045, according to Bellmunt, which compared pembrolizumab (Keytruda) with standard of care chemotherapy for second-line treatment and showed superiority for the checkpoint inhibitor. Quality of life was also much better for the patients who received immunotherapy, he notes.

In a similar trial design, IMvigor210 evaluated atezolizumab (Tecentriq) versus chemotherapy and demonstrated a clear benefit to the immunotherapy drug. Bellmunt concludes that based on this evidence, pembrolizumab is the first option but other favorable options are available as well.