Approved checkpoint inhibitors in bladder cancer: which drug should be used when?

Area of Science:

• Oncology
• Immunotherapy
• Urothelial Carcinoma Research

Background:

• Advanced metastatic urothelial carcinoma treatment has been revolutionized by checkpoint inhibitors.
• Five immune checkpoint inhibitors (pembrolizumab, atezolizumab, durvalumab, nivolumab, avelumab) are FDA-approved for second-line treatment post-cisplatin chemotherapy.
• Atezolizumab and pembrolizumab are approved for cisplatin-ineligible patients.

Purpose of the Study:

• To review the updated clinical efficacy of approved checkpoint inhibitors for advanced urothelial carcinoma.
• To propose optimal sequencing strategies for these agents alongside chemotherapy options.

Main Methods:

• Review of clinical efficacy data for approved checkpoint inhibitors.
• Analysis of phase III trial results comparing pembrolizumab and atezolizumab with chemotherapy.
• Consideration of treatment sequencing in cisplatin-eligible and ineligible patients.

Main Results:

• Platinum-based chemotherapy remains the first-line standard for cisplatin-eligible patients.
• Phase III trials indicate pembrolizumab is favored over atezolizumab for patients progressing on platinum-based therapy.
• Updated efficacy data supports the role of checkpoint inhibitors in advanced urothelial carcinoma.

Conclusions:

• Checkpoint inhibitors represent a significant advancement in treating advanced urothelial carcinoma.
• Pembrolizumab demonstrates superior efficacy in the second-line setting compared to atezolizumab after platinum-based chemotherapy.
• Strategic sequencing of checkpoint inhibitors with chemotherapy is crucial for optimizing patient outcomes.