Dr. Palmbos on the Role of Chemoimmunotherapy in Bladder Cancer

Phillip Palmbos, MD, PhD, assistant professor, University of Michigan Health, discusses the role of chemoimmunotherapy in patients with bladder cancer.

The phase 3 JAVELIN Bladder 100 trial (NCT02603432), which examined avelumab (Bavencio) in patients with locally advanced or metastatic urothelial cancer, established a survival benefit with the agent in the maintenance setting following first-line chemotherapy. Based on these findings, patients with stable or ongoing disease response after frontline cisplatin-based chemotherapy should be considered for treatment with the drug, according to Palmbos. These data provide insight into optimal sequencing and utilization of immune checkpoint inhibitors in this disease, Palmbos says.

However, chemoimmunotherapy still cannot be recommended for patients with metastatic bladder cancer, Palmbos continues. The phase 3 IMvigor130 trial (NCT02807636), which examined the addition of atezolizumab (Tecentriq) to platinum-based chemotherapy, showed an improved disease-free survival in patients with advanced or metastatic urothelial carcinoma, but did not demonstrate an improvement in overall survival, Palmbos explains. This was also the case when pembrolizumab (Keytruda) was combined with chemotherapy in the phase 3 KEYNOTE-361 trial (NCT02853305), Palmbos adds.

Although ongoing studies may provide more clarity on how chemoimmunotherapy regimens can be used in the treatment of this patient population, the approach does not currently have a clear role in this disease, Palmbos concludes.