Immunotherapy for GU Ca: A primer for urologists
Sequencing and earlier use
Other studies are investigating optimal sequencing of immunotherapy and other treatments.
The question of the preferred sequence of agents for treatment of patients with minimally or asymptomatic mCRPC was addressed by a consensus panel of members of the Society for Immunotherapy of Cancer, of which Dr. Petrylak was a member. Based on a review of the available evidence, nearly all (90%) of the panel members recommended using sipuleucel-T before an androgen receptor-targeted agent. They were unanimous in recommending the of sipuleucel-T or an androgen receptor-targeted agent prior to radium and chemotherapy.
A role for immunotherapy earlier in the disease course is also an area of research interest.
“As second-line treatment for bladder cancer, immunotherapy has survival benefits compared with chemotherapy. Now, ongoing trials are comparing these two categories as front-line therapy,” said Dr. Petrylak.
There is good rationale for investigating earlier use of immunotherapy, as available evidence shows that it tends to be more effective when the tumor burden is lower. This phenomenon may be explained by the fact that the tumor itself causes immune suppression, Dr. Kim said.
“We have entered into an exciting time when there is a whole new class of therapies available for patients who develop metastatic disease,” he said. “The next step will be testing them as neoadjuvant and adjuvant therapies for patients with high-risk localized disease, and the studies of neoadjuvant treatment will need to determine whether preoperative use of immunotherapy creates any safety issues for subsequent surgery.”
Dr. Kim noted that while immunotherapy for genitourinary cancers is currently in the realm of medical oncologists, urologists should be familiar with these agents and stay tuned for results from clinical trials investigating them as earlier intervention.
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