Optimizing outcomes for high-risk, non-muscle-invasive bladder cancer : The evolving role of PD-(L)1 inhibition
Bedke, Jens (Kilinikum Stuttgart)
Black, P.C. (University of British Columbia)
Szabados, B. (Queen Mary University of London)
Guerrero-Ramos, F. (Hospital 12 de Octubre (Madrid))
Shariat, S.F. (Medical University of Vienna)
Xylinas, Evanguelos (Université de Paris Cité)
Brinkmann, J. (Pfizer Pharma GmbH)
Blake-Haskins, J.A. (Pfizer Inc.)
Cesari, Rossano (Pfizer Inc.)
Palou, Juan (Institut d'Investigació Biomèdica Sant Pau)
Universitat Autònoma de Barcelona

Date:	2023
Abstract:	Transurethral resection of bladder tumor followed by intravesical Bacillus Calmette-Guérin (BCG) is the standard of care in high-risk, non-muscle-invasive bladder cancer (NMIBC). Although many patients respond, recurrence and progression are common. In addition, patients may be unable to receive induction + maintenance due to intolerance or supply issues. Therefore, alternative treatment options are urgently required. Programmed cell death (ligand) 1 (PD-[L]1) inhibitors show clinical benefit in phase 1/2 trials in BCG-unresponsive NMIBC patients. This review presents the status of PD-(L)1 inhibition in high-risk NMIBC and discusses future directions. PubMed and Google scholar were searched for articles relating to NMIBC immunotherapy and ClinicalTrials. gov for planned and ongoing clinical trials. Preclinical and early clinical studies show that BCG upregulates PD-L1 expression in bladder cancer cells and, when combined with a PD-(L)1 inhibitor, a potent antitumor response is activated. Based on this mechanism, several PD-(L)1 inhibitors are in phase 3 trials in BCG-naïve, high-risk NMIBC in combination with BCG. Whereas PD-(L)1 inhibitors are well characterized in patients with advanced malignancies, the impact of immune-related adverse events (irAE) on the benefit/risk ratio in NMIBC should be determined. Alternative routes to intravenous administration, like subcutaneous and intravesical administration, may facilitate adherence and access. The outcomes of combination of PD-(L)1 inhibitors and BCG in NMIBC are highly anticipated. There will be a need to address treatment resources, optimal management of irAEs and education and training related to use of this therapy in clinical practice.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article de revisió ; recerca ; Versió publicada
Subject:	BCG ; High risk ; Immune checkpoint inhibitors ; PD-(L)1 inhibition ; Non-muscle-invasive bladder cancer
Published in:	Urologic Oncology: Seminars and Original Investigations, Vol. 41 Núm. 12 (december 2023) , p. 461-475, ISSN 1873-2496

DOI: 10.1016/j.urolonc.2023.10.004
PMID: 37968169

15 p, 1.6 MB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles