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Immunotherapy for Muscle Invasive Bladder Cancer

A. Edward Yen, MD, Assistant Professor of Medicine in the Hematology and Oncology Section at Baylor College of Medicine in Houston, Texas, discusses the findings of recent immunotherapy trials for muscle invasive bladder cancer (MIBC). He explains that cisplatin-based neoadjuvant chemotherapy combinations are the current standard of care for MIBC and can provide a significant overall survival benefit, but 40 to 50% of patients are not eligible for cisplatin to begin with, and only 20% of those eligible patients actually receive cisplatin, which suggests that there are major therapeutic gaps that immunotherapies could potentially fill. Dr. Yen goes into depth on the findings of the phase II PURE-01 study of pembrolizumab, the phase II ABACUS study of atezolizumab, and the phase I NABUCCO study of nivolumab/ipilimumab, observing that all three therapies produced good responses and appeared to be correlated to different biomarkers from one another. He concludes by predicting that neoadjuvant immunotherapy will become standard of care for cisplatin-ineligible patients, but he also stresses that future studies should include higher-risk patients and should focus on predictive biomarkers.