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    Urothelial Ca immunotherapy approved for first-line use


    “The efficacy of atezolizumab thus far is striking, but it is not definitive. With long-term follow up, we may observe truly durable responses and possibly cures, suggesting that some patients may need only immunotherapy to treat their cancer. Data from at least 5 years of follow-up will be necessary to get a real understanding of the impact of atezolizumab on urothelial carcinoma.”

    Subgroup analyses showed responses occurred regardless of the level of PD-L1 expression in immune cells. Patients with lymph node only metastases and overall lower disease burden were most likely to respond.

    “Interestingly, patients with urothelial carcinoma who have these characteristics generally do well with any form of therapy tested so far, suggesting that the biology of cancer that is restricted to the lymph nodes is more favorable than that involving other organs such as the lung, bone, or the liver, in particular,” said Dr. Balar.

    “In fact, patients with liver metastases had an 8% response rate to atezolizumab, and so they are a subgroup deserving of intense focus for alternative or combination immunotherapy options.”

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

    The only Grade 3-4 adverse events occurring at a rate ≥5% were fatigue (8%), anemia (7%), urinary tract infection (5%), diarrhea (5%), and increase in serum creatinine (5%).

    Dr. Balar also suggested that the data from Cohort 1 in IMvigor210 signal a new paradigm in first-line treatment for urothelial carcinoma that may eventually expand to include use of atezolizumab in all patients. Data from the ongoing phase III IMvigor130 trial, however, are needed to define the scope of atezolizumab as initial therapy for advanced urothelial carcinoma. IMVigor130 is randomizing patients into three arms to receive platinum-chemotherapy or atezolizumab alone or in combination. It has a planned enrollment of approximately 1,200 patients and is including both cisplatin eligible and ineligible patients and will be the confirmatory study for atezolizumab’s accelerated first-line approval.

    Dr. Balar is a paid consultant and receives research support from Genentech/Roche, Merck, and Astra Zeneca.

    More from Urology Times:

    Prostate Ca: Immunotherapy consensus statement published

    Combination immunotherapy may raise response rate in mRCC

    Small molecule RNA inhibitor shows promise in PCa

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