Treatment combining the immunotherapy atezolizumab (Tecentriq) and platinum-based chemotherapy significantly improved progression-free survival in patients with previously untreated locally advanced or metastatic urothelial carcinoma compared to chemotherapy alone.
Adding the monoclonal antibody atezolizumab, which binds with programmed death ligand 1 (PD-L1), also appears to improve overall survival in these patients but the data are not yet mature, according to an Aug. 5 Roche press release on atezolizumab’s phase III IMvigor130 study.
IMvigor130 is a multicenter trial of 1,213 patients with metastatic urothelial carcinoma who have not received prior systemic therapy who were randomized to receive atezolizumab plus gemcitabine with either cisplatin or carboplatin; atezolizumab alone; or platinum-based chemotherapy with gemcitabine and either cisplatin or carboplatin plus placebo, according to the release, which does not include specific trial results. Roche will be sharing those with the FDA and other global health authorities, according to the release.
Also see: Hematuria evaluation approaches compared
“The interim analysis is clearly exciting and the approach is valid. This opens up the opportunity for using immunotherapy in a broader group of patients—even those who can tolerate chemotherapy. And if this combination ultimately does turn out to be positive and yield a survival benefit, it could potentially become standard of care in these patients,” said Badrinath Konety, MD, MBA, of the University of Minnesota, Minneapolis.
Atezolizumab is approved in the U.S. alone or in combination with targeted therapies or chemotherapies for certain types of metastatic urothelial cancer, forms of non-small cell and small cell lung cancer, and in PD-L1 positive triple-negative breast cancer. In 2017, atezolizumab failed a phase III trial in advanced bladder cancer when results didn’t show it could prolong patients’ lives. This was after phase II data showed a durable response to the drug.
Dr. Konety, who is not an investigator with Roche, said the news dampened enthusiasm for atezolizumab and other PD-LI inhibitors for advanced bladder cancer at the time. But these new phase III data are again encouraging because they show a clear synergistic benefit of immunotherapy and chemotherapy over standard of care.
“Of course, this is still the interim analysis. We don’t have a final analysis yet,” Dr. Konety said.
Unfortunately, bladder cancer patients treated with platinum-based chemotherapy tend to progress. And once they progress, there are not many options for second-line therapy.
Patients who have metastatic urothelial cancer have a median survival between 13 to 18 months with the standard of care: cisplatin-based chemotherapy. Some bladder cancer patients can’t tolerate cisplatin, which is toxic to the kidneys. So, doctors oftentimes use the less powerful carboplatin to treat these patients.