Daniel P. Petrylak, MD, presented “Management of BCG-Unresponsive Cystectomy-Ineligible Bladder Cancer Patients: Pembrolizumab” virtually during the Perspectives in Urology: Point Counterpoint 2020 virtual conference in November 2020.
How to cite: Petrylak, Daniel P. “Management of BCG-Unresponsive Cystectomy-Ineligible Bladder Cancer Patients: Pembrolizumab.” November 2020. Accessed Dec 2024. https://dev.grandroundsinurology.com/management-of-bcg-unresponsive-cystectomy-ineligible-bladder-cancer-patients/
Management of BCG-Unresponsive Cystectomy-Ineligible Bladder Cancer Patients: Pembrolizumab – Summary
Daniel P. Petrylak, MD, Director of Genitourinary Oncology, Professor of Medicine and Urology, Co-Leader of Cancer Signaling Networks, and Co-Director of the Signal Transduction Program at Yale University Cancer Center in New Haven, Connecticut, discusses alternatives to bacillus Calmette-Guerin (BCG) immunotherapy for non-muscle invasive bladder cancer (NMIBC), focusing on pembrolizumab. Dr. Petrylak gives an overview of NMIBC and of NMIBC management with BCG immunotherapy. He explains that BCG immunotherapy is standard of care for this difficult-to-treat disease state and has proven capable of reducing recurrence, progression, and death rates, but that there is a subset of patients who experience BCG failure. Dr. Petrylak describes the different kinds of BCG failure, including BCG-relapsing, BCG-intolerant, BCG-refractory, and BCG-resistant disease, and then discusses the limited treatments currently available for these patients. He observes that intravesical chemotherapies have not proven highly efficacious for NMIBC, but that immune checkpoint inhibitors like pembrolizumab show significant promise. Dr. Petrylak reviews the KEYNOTE-057 trial, which found that immune checkpoint therapy with pembrolizumab can lead to complete responses in 40% of patients, and the SWOG S1605 trial, which did not reach its endpoint but found a complete response to immune checkpoint therapy with atezolizumab at 6 months in 27% of patients. He concludes by discussing other ongoing and future trials to further evaluate checkpoint inhibitors for NMIBC.
About the Perspectives in Urology: Point Counterpoint 2020 virtual conference:
Presented by Program Chair and Grand Rounds in Urology Editor-in-Chief E. David Crawford, MD, as well as Program Co-Chair Dan Theodorescu, MD, PhD, this virtual conference brought together leading experts in urology, medical oncology, and radiation oncology to discuss and debate the latest topics in genitourinary cancers, primarily prostate cancer and bladder cancer. This two-day interactive conference offered topical lectures, pro/con debates, interesting-case presentations, interactive panel discussions, and interactive audience and faculty networking. A focus on prostate cancer was given on Wednesday, November 11th, with a focus on bladder cancer given on Thursday, November 12th.
ABOUT THE AUTHOR
Daniel P. Petrylak, MD, is currently Director of Genitourinary Oncology, Professor of Medicine and Urology, Co-Leader of Cancer Signaling Networks, and Co-Director of the Signal Transduction Program at Yale University Cancer Center in New Haven, Connecticut. He is a recognized international leader in the urology field. He earned his MD at Case Western Reserve University School of Medicine in Cleveland Ohio. He then went on to complete his Internal Medicine Residency at Albert Einstein College of Medicine/Jacobi Medical Center in the Bronx, and his fellowship at Memorial Sloan Kettering Cancer Center in New York.
Dr. Petrylak has served as principal investigator (PI) or co-PI on several SWOG clinical trials for genitourinary cancers. Most notably, he served as the PI for a randomized trial that led to the FDA approval of docetaxel in hormone refractory prostate cancer. He also helped to design and served as PI for the SPARC trial, an international registration trial evaluating satraplatin as a second-line therapy for hormone refractory prostate cancer.
Dr. Petrylak served on the program committees for the annual meetings of the American Urological Association from 2003-2011, and for the American Society of Clinical Oncology from 1995-1997 and 2001-2003. He also has served as a committee member for the Devices and Immunologicals section of the FDA. He has published extensively in the New England Journal of Medicine, Journal of Clinical Oncology, Journal of the National Cancer Institute, Cancer Research, and Clinical Cancer Research.
