AUA 2017: High Risk Non-Muscle Invasive Bladder Cancer
Dr. Kassouf presented the pro-BCG stance noting that this has been a therapeutic mainstay for over 40 years. In randomized trials it has been shown to decreases recurrences, and can reduce risk of progression if maintenance is used. He emphasized the AEs with immunotherapy, and a different risk threshold in the NMIBC setting.
Dr. Drake reviewed the immunological mechanisms and innate (neutrophils) vs adaptive (memory CD8 T-cells) immune responses. He underscored that we still don't completely understand how BCG works. He emphasized that the immune AEs, are usually limited to the first year or so, so long term safety is fairly well known. Trials are currently accruing to address the activity of checkpoint blockade in NMIBC. Keynote -057 is a phase II single arm trial investigating pembrolizumab in the BCG unresponsive setting. S1605 is a similar design with atezolizumab.
Finally, ADAPT-BLADDER is randomizing BCG relapsing NMIBC patients to durvalumab + BCG, durvalumab + EBRT, or BCG followed by durvalumab. He ended by admitting that PDL-1 expression is less strong in NMIBC, but that the rationale was still strong enough to perform the trials, as patients with low PDL-1 expression still have responses in the MIBC setting.
Presented by: Wassim Kassouf, MD McGill University and Charles Drake, MD, PhD Columbia University Medical Center
Contributed by: Jed Ferguson, MD/PhD and Ashish Kamat, MD. MD Anderson Cancer Center, Department of Urology.
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA