Phase II Trial Considers the Benefit of Switch Maintenance in Urothelial Cancer

Matthew Galsky, MD, director, Genitourinary Medical Oncology, The Tisch Cancer Institute, Mount Sinai Hospital, discusses how the phase II HCRN GU14-182 study helps to define the role of switch maintenance therapy in patients with urothelial cancer. The study looked at maintenance with pembrolizumab (Keytruda) versus placebo following frontline chemotherapy in patients with metastatic urothelial cancer.

In a few randomized phase III studies, immune checkpoint blockade has already been integrated as a switch maintenance strategy following chemotherapy. Responses seen in these trials could be due to the immune checkpoint inhibitor, the chemotherapy, or the combination, says Galsky. The HCRN GU14-182 study helps define what maintenance may provide for this patient population, but this is still not an “apples to apples” comparison.

As researchers continue to look at combination maintenance approaches, Galsky says it is important to step back and consider what they hope to achieve in this setting. The hope of using immune checkpoint blockade is to improve or maintain responses. At the same time, patients can have a break from the toxicities of chemotherapy.