Pembrolizumab for the treatment of bladder cancer

ABSTRACT

Introduction: Until recently, patients with locally advanced or metastatic urothelial carcinoma after progression on cisplatin-containing chemotherapy had limited systemic treatment options with no significant survival benefit and poor tolerability. Advances in the field of immunotherapy with the introduction of checkpoint inhibitors have led to paradigm shifts in the treatment of various malignancies.

Areas covered: The current review will summarize the clinical evidence of checkpoint inhibitors in bladder cancer, with a focus on pembrolizumab.

Expert commentary: Category 1 evidence indicates that the checkpoint inhibitor pembrolizumab improves overall survival in patients with locally advanced or metastatic urothelial carcinoma who progressed after or during cisplatin-containing therapy as compared to current standard of care chemotherapy. Phase 1 and 2 evidence also indicates that checkpoint inhibitors are active in first line in patients who are ineligible for cisplatin-containing chemotherapy.

KEYWORDS:

• Pembrolizumab
• bladder cancer
• checkpoint inhibitors
• urothelial carcinoma
• immunotherapy

Information resources

• Bellmunt et al. Pembrolizumab as Second-Line Therapy for Advanced Urothelial Carcinoma. NEJM 2017.

• Balar et al. First-line pembrolizumab in cisplatin-ineligible patients with locally advanced and unresectable or metastatic urothelial cancer (KEYNOTE-052): a multicenter, single-arm, phase 2 study. Lancet Oncol 2017.

• Herrera et al. Radiotherapy combination opportunities leveraging immunity for the next oncology practice. CA Cancer J Clin 2017.

Declaration of interest

P Ost is the principal investigator on an investigator initiated phase I trial funded by Merck. S Rottey and D De Maeseneer have both received an unrestricted research grant from Roche. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. Merck provided a scientific accuracy review at the request of the journal editor.

Additional information

Funding

This manuscript has received no funding.