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PEER-TO-PEER CLINICAL CONVERSATIONS
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Pembrolizumab in Combination With Gemcitabine and Concurrent Hypofractionated Radiation Therapy As Bladder Sparing Treatment for Muscle-Invasive Bladder Cancer
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Arjun Balar, MD
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| In this conversation with Alicia Morgans, Arjun Balar highlights a multicenter study first designed in 2014 of gemcitabine hypofractionated radiation therapy and pembrolizumab all in combination as bladder-sparing therapy for patients with muscle-invasive bladder cancer that had a total of 54 patients.
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Steps Toward a Bladder-Intact Cure for Muscle-Invasive Bladder Cancer
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Andrea Necchi, MD
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| In this conversation with Alicia Morgans, Andrea Necchi highlights several abstracts including a US phase II study presented by Arjun Balar of immunotherapy with pembrolizumab combined with chemoradiation, hypofractionated radiotherapy combined with gemcitabine in patients with D2-D4-N0 muscle-invasive bladder cancer (MIBC), and a multicenter study, presented by Javier García del Muro, combined immunotherapy with durvalumab and tremelimumab and radiotherapy as a chemotherapy-free strategy for bladder preservation in MIBC in the same patient population.
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HCRN GU 16-257 a Phase 2 Trial of Gemcitabine, Cisplatin, Plus Nivolumab Shows Promise for Bladder-Sparing in Muscle- Invasive Bladder Cancer (MIBC)
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Matthew Galsky, MD
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| In this conversation with Alicia Morgans, Matthew Galsky highlights data he presented at ASCO 2021 evaluating an approach to treating muscle-invasive bladder cancer that spares patients from undergoing cystectomy or a directed, definitive local therapy in the phase 2 trial of gemcitabine, cisplatin, plus nivolumab with selective bladder sparing in patients with muscle-invasive bladder cancer: HCRN GU 16–257.
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| Phase II Trial of Durvalumab Plus Tremelimumab With Concurrent Radiotherapy in Patients With Localized Muscle Invasive Bladder Cancer Treated With a Selective Bladder Preservation Approach: IMMUNOPRESERVE-SOGUG Trial
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| Xavier Garcia del Muro, MD, Ph.D.
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| In this presentation, Dr. Garcia del Muro presented data from the IMMUNOPRESERVE-SOGUG trial, which aimed to test combined immunotherapy with durvalumab and tremelimumab and radiotherapy as a chemotherapy-free strategy for bladder preservation in muscle invasive bladder cancer (MIBC).
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| Pembrolizumab in Combination With Gemcitabine and Concurrent Hypofractionated Radiation Therapy As Bladder Sparing Treatment for Muscle-Invasive Bladder Cancer: A Multicenter Phase 2 Trial |
| Arjun Balar, MD |
| Arjun Balar presented results of their phase 2 trial evaluating the safety and efficacy of pembrolizumab added to trimodality bladder preservation therapy in muscle-invasive bladder cancer. Pembrolizumab added to hypofractionated radiotherapy and twice weekly gemcitabine was well-tolerated with promising efficacy in this early analysis: 88% rate of bladder intact disease-free survival at 1 year in the efficacy cohort is noteworthy, but longer follow-up is needed. |
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| Steps Toward a Bladder-Intact Cure for Muscle-Invasive Bladder Cancer |
| Andrea Necchi, MD |
| Andrea Necchi presents a steps toward a bladder-intact cure for muscle-invasive bladder cancer. The possibilities to improve or overcome the current therapeutic protocols by introducing immunotherapy will benefit from improvements in (i) harmonization of terminology and definitions of trial endpoints, (ii) longer follow-up time to confirm associations with outcomes, (iii) a substantial raise in the bar of therapeutic efficacy given that the benchmark chemoradiation therapy is hard to beat, and (iv) results from randomized trials to assess the magnitude of immunotherapy benefit. |
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| Phase 2 Trial of Gemcitabine, Cisplatin, Plus Nivolumab With Selective Bladder Sparing in Patients With Muscle-Invasive Bladder Cancer: HCRN GU 16–257 |
| Matt Galsky, MD |
| Matt Galsky presented results of the phase 2 trial HCRN GU 16-257 assessing gemcitabine, cisplatin, plus nivolumab with selective bladder sparing in patients with muscle-invasive bladder cancer. TURBT plus gemcitabine, cisplatin, plus nivolumab achieves stringently defined clinical complete response in a large subset of patients with muscle-invasive bladder cancer. |
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| Practical Considerations for the Treatment of Patients on Long-term Immunotherapy |
| Mamta Parikh, MD, MS |
| The Plenary agenda of the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting included a session, entitled “So Your Patient with Kidney or Bladder Cancer Responded to Immunotherapy: What's Next?”. In this context, Dr. Mamta Parikh discussed considerations for the treatment of patients who respond well to immunotherapy and are on therapy for a long time. |
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| Immunotherapy as Curative Therapy in Advanced Kidney and Bladder Cancer: Fantasy or Reality? |
| Thomas Powles, MD |
Tom Powles discussed whether we can consider immunotherapy a truly curative approach for patients with advanced kidney and bladder cancer. He emphasized that cure is the long-term, durable elimination of cancer. While there are many ways to assess this, he suggested that complete response is not the best. Over the past few decades, we have seen advances in “cure” through better treatments. However, so far, biomarkers have not meaningfully changed the treatment paradigm thus far.
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