(UroToday.com) The 2022 Annual Meeting of the American Urological Association was host to a discussion section led by Dr. Stephen B. Williams regarding systemic therapy for muscle-invasive bladder cancer. This discussion followed the presentation by Dr. Matthew Galsky.
As Dr. Galsky had done previously, Dr. Williams began his discussion by highlighting the currently available phase 2 trials exploring neoadjuvant immunotherapy for muscle-invasive bladder cancer. These trials have demonstrated pT0N0 rates of 7-46%, which are similar to those seen with historical neoadjuvant chemotherapy regimens.
There are also currently numerous ongoing phase 3 trials integrating immunotherapy agents into neoadjuvant regimens.
With respect to future clinical trial designs, Dr. Williams raised these questions:
- Is pT0 truly the ‘holy grail’ endpoint?
- Can definitions of ‘high risk’ groups beyond clinical predictors (i.e. hydronephrosis, pathologic stage, etc.) be improved upon?
- What are the next phase(s) for neoadjuvant trials to test (i.e. Beyond combo)?
Dr. Williams next highlighted again the paucity of data for adjuvant chemotherapy in the muscle-invasive disease space. An editorial by Sumanta Pal et al. published in the Journal of Clinical Oncology raised the question of whether we need to use population-based data to fill a void of prospective evidence.1
With regards to the adjuvant space, Dr. Williams raised the following questions:
- Have we learned the appropriate lessons regarding the prognostic value of ctDNA status from IMvgor010?
- Should results from Checkmate-274 make nivolumab adjuvant standard therapy?
- Any other thoughts regarding current or future adjuvant trial design i.e. AMBASSADOR?
Dr. Williams ended his presentation with the famous quote from Winston Churchill: “Success is going from failure to failure without losing enthusiasm.”
Presented By: Dr. Stephen B. Williams, MD, MS, Associate Professor and Chief, Division of Urology, University of Texas Medical Branch Health, Galveston, TX
Written By: Rashid Sayyid, MD, MSc – Urology Chief Resident, Augusta University/Medical College of Georgia, @rksayyid on Twitter during the 2022 Annual Meeting of the American Urological Association, New Orleans, LA, May 13 – 16, 2022
References:
- Pal SK, Agarwal N,m Grivas P, Choueiri T. Adjuvant Chemotherapy for Bladder Cancer: Using Population-Based Data to Fill a Void of Prospective Evidence. J Clin Oncol. 2016;34(8):777-779.