Updates in the Bladder Cancer Space Lead to Changes in NCCN Guidelines

Thomas Flaig, MD, vice chancellor of research for the University of Colorado Denver, member, University of Colorado Cancer Center, and the University of Colorado Anschutz Medical Campus, Chair of the National Comprehensive Cancer Network (NCCN) Guidelines Panel for Bladder Cancer, discusses recent updates seen in the bladder cancer space and how they have led to changes to the NCCN guidelines.

With numerous advances and developments made for patients with bladder cancer, NCCN guidelines have been updated. One of the most recent additions to the guidelines is that the use of avelumab (Bavencio) as maintenance therapy has been added.

Another update has come with the emergence of immune checkpoint inhibitors (ICIs). According to Flaig, while they started out as later-line therapy options, ICIs are now listed in the NCCN guidelines as first-line treatment options for cisplatin-ineligible patients with PD-1-positive or platinum-ineligible disease.

Transcription:

0:08 | One thing that has really defined the treatment of bladder cancer patients in the last 5 years or so has been the introduction of immune checkpoint inhibitors. These initially started out as a later-line of therapy and these agents are now being tested and integrated across different disease states. It became apparent early on that bladder cancer was going to be an area of special interest for these agents with clear activity. We saw the introduction of multiple immune checkpoint inhibitors, again, in a later-line, advanced metastatic setting.

0:51 | More recently, we have seen the introduction of immune checkpoint inhibitors in the non-muscle invasive BCG-unresponsive setting. In a different clinical indication, we've seen the introduction of immune checkpoint inhibitors in the high-risk adjuvant or post-operative setting as well. We've seen broad testing of these agents and now the maturation of these results to where immune checkpoint inhibitors are applied in diverse settings across the disease spectrum.