Immunotherapy for bladder cancer – pro
Atezolizumab, durvalumab, avelumab, pembrolizumab and nivolumab are all currently FDA-approved and recommended for treatment of patients with locally advanced or metastatic urothelial carcinoma previously treated with platinum-based chemotherapy or relapsed within 12 months of perioperative platinum-based chemotherapy. Atezolizumab and pembrolizumab are also recommended as first-line theraphy in cisplastin-ineligible patients Pembrolizumab demonstrated improved survival and is the only agent with Level A evidence at this time. There are currently no evident reasons to select one agent over the others, other than the practical matters of dosing and convenience.pembrolizumab is an appropriate choice of treatment in any patient whose tumor has the MSI-H biomarker and whose disease has progressed following prior treatment, with no satisfactory alternative treatment options.
What about treating with one of these drugs after failing another? Unfortunately, no studies of this approach have so far been published and such approach remains E/I and not med necessary at this time.
Ashish M. KamatEmail author, Joaquim Bellmunt, Matthew D. Galsky, Badrinath R. Konety, Donald L. Lamm, David Langham, Cheryl T. Lee, Matthew I. Milowsky, Michael A. O’Donnell, Peter H. O’Donnell, Daniel P. Petrylak, Padmanee Sharma, Eila C. Skinner, Guru Sonpavde, John A. TaylorIII, Prasanth Abraham and Jonathan E. Rosenberg, Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of bladder carcinoma. Journal for ImmunoTherapy of Cancer20175:68
NCCN, Bladder Cancer 2017