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    Immunotherapy treats Ca based on genetic feature


    “T cell checkpoint therapy is being explored in combination with other immune-oncology agents within multiple genitourinary cancers,” said Akash Patnaik, MD, PhD, MMSc, assistant professor of medicine, director of the Developmental Therapeutics Laboratory, and attending physician within the genitourinary oncology program at the University of Chicago Medicine. “These strategies should result in significant advancements within the next 5 years.”

    Data have previously supported use of another immunotherapy—atezolizumab (Tecentriq), which blocks the ligand for PD-1 called PD-L1—in urothelial cancers, but pembrolizumab works differently, directly inhibiting the PD-1 receptor and enhancing T-cell activation.

    Speaking in regard to other genitourinary cancers, “Immunotherapy has historically not been as successful in treating prostate cancer,” Dr. Patnaik said.

    In one recent study, however, Dr. Patnaik said a small subset—three of 10 patients—with very advanced prostate cancer had a significant response to pembrolizmab, so his team is investigating the genetic and molecular basis for why some patients respond to immunotherapy and what treatment or combination of treatments might be most effective.

    Read: Should RCC immunotherapy continue after progression?

    “Immunotherapy has clearly revolutionized the management of urothelial cancers,” Dr. Patnaik said. “There is far less toxicity than standard treatment methods, and it can be used in elderly patients with kidney function abnormalities. This is a major step forward and the efficacy is quite promising.”

    Merck made the first presentation of the results of two studies evaluating the 1-year follow-up of pembrolizumab at the American Society of Clinical Oncology annual meeting in Chicago. The updated survival and biomarker analysis reveals that pembrolizumab had a 29% overall response rate as a first-line therapy in treating urothelial cancer, and reduced the risk of death by 30% as a second-line therapy when compared to chemotherapy, according to Merck.

    The therapy does come with some side effects, particularly in the development of autoimmune disorders such as immune-mediated pneumonitis, autoimmune hepatitis, colitis, and hypothyroidism. Pembrolizumab seems to result in in a lower incidence of autoimmune side effects than therapies targeting CTLA-4 such as ipilimumab (Yervoy), but reactions can still occur, Dr. Patnaik said. In those cases, autoimmune reaction can be successfully managed with steroid therapy.

    In clinical trials, patients with autoimmune disease were excluded, but recent observations at the ASCO annual meeting have shown that there was not a particularly higher incidence of side effects in these populations when treated with immunotherapy, Dr. Patnaik said. Pembrolizumab can also cause serious transfusion reactions, in which case the therapy should be discontinued, according to Merck.

    More from Urology Times:

    Urothelial Ca immunotherapy approved for first-line use

    Has the USPSTF gone far enough with its new PCa grade?

    Small molecule RNA inhibitor shows promise in PCa

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    Rachael Zimlich, RN
    Ms Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and ...


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