Strategies for Optimizing Immune Checkpoint Inhibition in Urothelial Carcinoma

Thomas Powles, MD, MBBS, MRCP, director, Barts Cancer Institute, discusses how researchers are working to optimize treatment with immune checkpoint inhibitors for patients with urothelial carcinoma.

This is the big question he has been asked over the last 12 months, Powles says, with the latest development of new therapies for patients with urothelial carcinomas. The movement of checkpoint inhibitors has primarily been in the perioperative and neoadjuvant spaces, and the story of checkpoint inhibitors has been primarily in metastatic disease.

Checkpoint inhibition has proven itself effective with durable, long-term remissions in about a fifth of patients, but Powles says that we want to improve upon this further. This can be done with 3 different strategies, which include combination therapy, the use of biomarkers, and bringing the therapy earlier on in the disease course. So far, immunotherapy combinations have not been successful in this setting, and biomarkers are often quite complex in the metastatic space, which makes this a major challenge in moving the checkpoint inhibitors forward.

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