Bladder Cancer Update & Renal Cell Cancer Update, 2017 (Video Program)Ongoing trials evaluating immune checkpoint inhibitors in the adjuvant and metastatic settings
3:53 minutes.
TRANSCRIPTION:
DR LOVE: What are some of the new trial concepts and new trials that are ongoing right now in checkpoint inhibitors that you think are most important for oncologists to know about? DR GALSKY: So there are a number of trials in the adjuvant setting. We spoke about adjuvant therapy as really being an unmet need for a couple of reasons: (1), because the data has been a little bit less compelling than in the neoadjuvant setting, although probably for a number of clinical trial-related reasons. The other is because a large proportion of our patients can’t receive cisplatin-based chemotherapy because of renal function or other comorbidities. And so there are at least 3 trials, randomized Phase III trials, exploring adjuvant immune checkpoint blockade in patients with bladder cancer, 1 exploring nivolumab, 1 exploring atezolizumab and a cooperative group trial that will be up and running in the not-too-distant future exploring pembrolizumab. Importantly, all of these trials enroll patients who have either T3 disease or higher or node-positive disease at the time of cystectomy who are cisplatin ineligible or who refuse adjuvant chemotherapy but also enroll patients who’ve had neoadjuvant chemotherapy and have residual disease in the bladder, T2 disease or higher. And that’s really a major unmet need, that population. And so the results from these trials are, of course, eagerly awaited. The next set of very important trials are trials being done in the first-line treatment setting, the chemotherapy-naïve first-line metastatic setting. And there are a number of Phase III trials which are potentially practice changing, which are going on in that space. There’s a trial combining durvalumab with tremelimumab, a combination of PD-L1 blockade and CTLA-4 blockade, versus durvalumab alone, PD-L1 blockade alone versus standard-of-care chemotherapy. There’s a trial being done with atezolizumab in cisplatin-ineligible patients with metastatic disease, randomizing patients between gemcitabine and carboplatin with placebo versus gemcitabine and carboplatin with atezolizumab. So these trials, asking really different questions, have the potential to change how we treat patients in a dramatic way. DR LOVE: At this point when you look at the various checkpoint inhibitors from your point of view, does it seem like they’re essentially equivalent both in terms of efficacy and toxicity? There is the issue of the interval of every 2 or 3 weeks. I don't know if you consider that a significant difference. DR GALSKY: So as I look across the data that we have so far, I do think that these treatments look pretty similar both in terms of safety and in terms of efficacy. There are some differences in the antibodies. There’s some theoretical differences in mechanism of action. But really when you look at the data, it looks quite similar. The schedule issue, I think, is an interesting one, because I would think that a treatment that’s administered less often would be favored by patients, or at least potentially, although I’ve heard recently from a number of colleagues with patients telling them that they don’t mind coming in more frequently — in fact, they feel more comfortable being seen, being under care, with that frequency. They feel safer to some extent. So I think that we place some value judgments on that, but I’m not sure we actually know how all of our patients feel in that regard. Of course there are some financial issues that need to be considered as well. |