Opinions on Treatment Split for Prominent Questions in Bladder Cancer

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Matthew R. Zibelman, MD, associate professor in the Department of Hematology/Oncology, director of Genitourinary Clinical Research, and director of Clinical and Translational Research, GU Service Line at Fox Chase Cancer Center, discusses differing opinions in muscle-invasive bladder cancer treatment he heard when moderating a Case-Based Roundtable event.

He said that participating oncologists debated the use of immunotherapy compared with platinum-based chemotherapy in adjuvant high-risk bladder cancer. The standard of care in this space used to be chemotherapy, but now nivolumab (Opdivo) is also considered based on data from the phase 3 CheckMate 274 trial (NCT02632409). According to Zibelman, some participants now consider nivolumab as standard for the majority of these patients.

Another topic of event discussion was in reference to the phase 3 NIAGARA trial (NCT03732677). This randomized trial showed efficacy with perioperative durvalumab (Imfinzi) plus neoadjuvant chemotherapy in muscle-invasive bladder cancer. Participants took sides on whether they would use this regimen to treat patients with have achieved a complete response (CR) after surgery or avoid additional therapy.

TRANSCRIPTION:

0:10 | It's very interesting to see clinicians’ perspectives of the adjuvant setting, in particular with using the new immunotherapy options such as nivolumab vs when to still consider platinum-based chemotherapy, which had been an option [that was] standard for a long time. There did seem to be a little bit of a split amongst the participants about who would still be comfortable and prioritize using platinum-based therapies in that setting vs who feels that immunotherapy really has become the standard of care for the majority of patients. I think that part of the discussion was interesting.

0:47 | Then I think with the new NIAGARA data, whether to still give treatment after surgery in patients who've had a CR is something that is an interesting question in the field. I think it was a good topic of discussion. [It] somewhat surprised me about people who—whether they're willing to just keep giving a therapy, even in patients who've had a CR, vs others who do see that in some of those patients, maybe continuing treatment is not necessary.