Adjuvant Checkpoint Inhibition in Urothelial Cancer

Several studies at the 2021 virtual American Society of Clinical Oncology (ASCO) annual meeting were focused on the increased use of immune checkpoint inhibitors across various settings in urothelial bladder cancer.

In this video, courtesy of VJHemOnc, Srikala S. Sridhar, MD, of Princess Margaret Hospital in Toronto, Canada, gives a brief description of the promising studies and how they might change practice in the adjuvant setting.

Following is a transcript of her remarks:

Like anything in oncology, when it works in advanced disease, it gets moved earlier and earlier. And so of course we’ve seen it first in the advanced setting, KEYNOTE-045, that led to the approval of pembrolizumab [Keytruda] in the post-chemotherapy setting.

A number of other immune checkpoint inhibitors have also been evaluated in that setting. And then it’s been looked at certainly in the maintenance setting, as we just spoke about, and then in the frontline setting, and now it’s moving into the muscle-invasive bladder cancer setting, where we currently have three trials that we can sort of talk about briefly looking at the immune checkpoint inhibitors in the adjuvant setting.

So of course there was IMvigor010, that looked at atezolizumab [Tecentriq], and this was a negative study. More recently, there was CheckMate 274, that looked at nivolumab [Opdivo]. And this was a positive study as far as DFS [disease-free survival] is concerned. So about 20.6 versus 10.9 months — very encouraging data. This was, I think, recently published in the New England Journal of Medicine.

And then there’s the AMBASSADOR study that’s looking at pembrolizumab in this setting.

And then there’s even a follow-up study to the IMvigor010 study, being the IMvigor011 study, that is looking at the subset of patients that have positive [circulating tumor] DNA and looking at whether or not in that subset of patients, adjuvant immunotherapy has a beneficial role.

And so that’s sort of what’s happening in the adjuvant setting.

And then there’s even interest in the neoadjuvant setting, based on peer and advocates and a host of other studies looking at either IO [immunotherapy] alone or IO in combination. And then of course, KEYNOTE-057 is looking even in the non-muscle invasive setting in the BCG [Bacillus Calmette-Guerin]-refractory group of patients.

And so as these drugs move earlier, a key question is going to be, how do we sequence these treatments going forward? So what happens when patients progress and whether or not we can reuse these treatments, and can they be used again after a defined period of time or an intervening treatment?