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Published on: October 30, 2013
New immunotherapies for high-risk non-muscle invasive bladder cancer: Current state and future perspectives
C Gómez Del Cañizo1, M Rodríguez-Izquierdo Jiménez1, E Peña Vallejo1
1Unidad de Uro-Oncología, Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España.
Background:
The standard treatment for high-risk non-muscle invasive bladder tumors (NMIBT) is transurethral resection of the bladder and BCG instillations. However, responses are limited, and new therapeutic alternatives for these patients are required. The results of checkpoint inhibitors in advanced tumors have led to interest in the use of these molecules in NMIBT.
Methods:
We conducted a search on PubMed using the terms «bladder cancer» and «check point inhibitors». We have used the search engines clinicaltrials.gov and clinicaltrialsregister.eu for the search of clinical trials.
Results:
There are currently 5 trials in progress on BCG untreated patients. There are no results available. As for BCG non-responders, there are 15 ongoing trials, two of them with preliminary results: Keynote 057, with promising results with pembrolizumab, which has led the FDA to approve its use in January 2020, and SWOG S1605, which has shown similar results with atezolizumab. Other trials are using intravesical administration of these drugs, which is an attractive option if it is effective for cancer control.
Conclusions:
Checkpoint inhibitors offer a new possibility for patients who do not respond to BCG. These will probably be used in the future for previously BCG untreated patients. Preliminary data from clinical trials show promising results. A good understanding of these molecules by urologists and the creation of multidisciplinary teams are crucial in order to offer the best therapeutic alternatives to these patients.
Insights
Checkpoint inhibitors show promise as a new treatment for non-muscle invasive bladder tumors (NMIBT) when standard Bacillus Calmette-Guerin (BCG) therapy fails. Further research is ongoing to explore their efficacy in BCG-untreated patients.
Area of Science:
- Uro-oncology
- Immunotherapy
Background:
- Standard treatment for high-risk non-muscle invasive bladder tumors (NMIBT) involves transurethral resection and Bacillus Calmette-Guerin (BCG) instillations.
- Limited response rates and the need for novel therapeutic strategies highlight the importance of exploring new treatments for NMIBT.
- The success of checkpoint inhibitors in advanced cancers has spurred interest in their application for NMIBT.
Purpose of the Study:
- To review the current landscape of checkpoint inhibitors in the treatment of non-muscle invasive bladder tumors (NMIBT).
- To assess the preliminary efficacy and ongoing research of checkpoint inhibitors in BCG-untreated and BCG-refractory NMIBT patients.
Main Methods:
- A literature search was conducted on PubMed using keywords «bladder cancer» and «check point inhibitors».
- Clinical trials were identified using clinicaltrials.gov and clinicaltrialsregister.eu.
Main Results:
- Fifteen ongoing clinical trials are investigating checkpoint inhibitors in BCG non-responder NMIBT patients, with two trials (Keynote 057 and SWOG S1605) showing promising preliminary results with pembrolizumab and atezolizumab, respectively.
- Pembrolizumab received FDA approval in January 2020 for specific NMIBT cases based on positive trial outcomes.
- Five trials are currently evaluating checkpoint inhibitors in BCG-untreated NMIBT patients, though results are pending. Intravesical administration is also being explored.
Conclusions:
- Checkpoint inhibitors represent a significant new therapeutic avenue for NMIBT patients, particularly those who do not respond to BCG therapy.
- These agents are anticipated to play a future role in the treatment of BCG-untreated NMIBT.
- Urologist education on these novel agents and the establishment of multidisciplinary teams are essential for optimal patient management and selection of the best therapeutic options.
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