Dr. Gupta on Neoadjuvant Versus Adjuvant Immunotherapy in Urothelial Carcinoma

Shilpa Gupta, MD, medical oncologist, Department of Hematology and Medical Oncology, Cleveland Clinic, discusses the potential utility of neoadjuvant versus adjuvant immunotherapy in urothelial carcinoma.

The randomized phase 3 IMvigor010 trial failed to meet its primary end point of disease-free survival with adjuvant atezolizumab (Tecentriq) in patients with muscle-invasive urothelial carcinoma.

However, the trial did not include patients who had high-risk disease features such as margin positivity, says Gupta.

The hypothesis of whether neoadjuvant immunotherapy may have utility in this patient population has been posed, explains Gupta.

For example, the randomized phase 3 MK-3475-905/KEYNOTE-905 trial is evaluating the use of perioperative pembrolizumab (Keytruda) plus cystectomy versus cystectomy alone in patients with cisplatin-ineligible muscle-invasive bladder cancer.