A true revolution in the management of advanced genitourinary cancers has occurred with the discovery and adoption of immunotherapy (IO). The therapeutic benefits of IO were recently observed not to be solely confined to patients with disseminated disease but also in select patients with localized and locally advanced genitourinary neoplasms.
KEYNOTE-057 demonstrated the benefit of pembrolizumab monotherapy for treating high-risk nonmuscle invasive bladder cancer unresponsive to bacillus Calmette-Guérin (BCG), resulting in recent US Food and Drug Administration approval. Furthermore, a current phase 3 trial (Checkmate274) demonstrated a disease-free survival benefit with the administration of adjuvant nivolumab vs placebo in muscle-invasive urothelial carcinoma after radical cystectomy. In addition, the recent highly publicized phase 3 KEYNOTE 564 trial demonstrated a recurrence-free survival benefit of adjuvant pembrolizumab in patients with high-risk localized/locally advanced kidney cancer.
The adoption and integration of IO in the management of localized genitourinary cancers exhibiting aggressive phenotypes are becoming an emerging therapeutic paradigm. Clinical oncologists and scientists should become familiar with these trials and indications because they are likely to dramatically change our treatment strategies in the months and years to come.
JAMA oncology. 2023 Aug 10 [Epub ahead of print]
Andrea Necchi, Bishoy M Faltas, Susan F Slovin, Joshua J Meeks, Sumanta K Pal, Lawrence H Schwartz, Richard S P Huang, Roger Li, Brandon Manley, Jad Chahoud, Jeffrey S Ross, Philippe E Spiess
Vita-Salute San Raffaele University; IRCCS San Raffaele Hospital, Milan, Italy., Englander Institute for Precision Medicine, Weill Cornell Medicine-NewYork Presbyterian Hospital. New York, New York., Genitourinary Oncology Service, Department of Medicine, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, New York., Departments of Pathology, Urology, Biochemistry and Molecular Genetics, Northwestern University School of Medicine, Chicago, Illinois., Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California., Department of Radiology, Columbia University College of Physicians and Surgeons, New York, New York., Foundation Medicine, Cambridge, Massachusetts., Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida.