Daniel P. Petrylak, MD, presented “Updates on Immunotherapy for Bladder Cancer” during the 19th Annual Future Directions in Urology Symposium on August 11, 2018 in Colorado Springs, Colorado.
How to cite: Petrylak, Daniel P.. “Updates on Immunotherapy for Bladder Cancer” August 11, 2018. Accessed [date today]. https://dev.grandroundsinurology.com/updates-on-immunotherapy-for-bladder-cancer/
Updates on Immunotherapy for Bladder Cancer – Summary:
Daniel P. Petrylak, MD, discusses new treatments for metastatic bladder cancer and the importance of accurate PD-L1 markers. He also offers his predictions for bladder cancer checkpoint inhibitor therapy and second-line agents for patients who do not respond to checkpoint inhibitors.
Updates on Atezolizumab and Pembrolizumab
The FDA has approved atezolizumab and pembrolizumab for frontline therapy in platinum ineligible patients, but recently issued a warning against using these drugs in patients who do not express PD-L1. Because of this warning, it is important to assess the PD-L1 status of patients, which requires also assessing the accuracy of biomarker assays for PD-L1.
Prognostic Factors for Metastatic Urothelial Carcinoma (mUC)
PD-L1 may also be predictive and prognostic for patients with mUC. Urologists are currently considering including mutational burden as a prognostic factor of mUC and response to checkpoint inhibition therapy.
The Future of Checkpoint Inhibition Therapy in Bladder Cancer
Dr. Petrylak predicts that, in the future, urologists will use checkpoint inhibition therapy with either a gemcitabine/cisplatin or cisplatin/carboplatin combination as frontline therapy. If this shift occurs, the second line therapy space will open for other agents.
Emerging Agents
An example of other agents for advanced or mUC is enfortumab vedotin, an antibody drug conjugate that demonstrates activity in patients who failed checkpoint inhibitor therapy or patients with liver metastases. Enfortumab vedotin may be a possible second-line therapy in the future.
A large phase II trial completed looking at enfortumab vedotin as second-line therapy, and aims to get the agent accelerated approval for mUC. Additionally, the randomized trial EV-301 will compare enfortumab vedotin to chemotherapy.
IME-132 is also a drug in this class with breakthrough status under evaluation in this setting.
About Dr. Petrylak
Dr. Petrylak is the head of the advanced bladder cancer Southwest Oncology Group (SWOG) Genitourinary Committee and is involved in clinical trials research on an international level. Due to this experience, he has extensive knowledge in bladder cancer, mUC, and specific drugs for this disease state and their approvals.
About the Future Directions in Urology Symposium
The Future Directions in Urology Symposium (FDUS) is an annual collaborative meeting with a faculty consisting of the top researchers, physicians, and educators in the field of urology. During FDUS, experts provide updates on recent developments and debate innovative management approaches in genitourinary cancers and urologic conditions. Subsequently, the experts devise consensus statements in accordance with the discussions held in the meeting.
In this video, Dr. Petrylak discloses the thesis of the discussion he led during FDUS.
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.
