Immune checkpoint therapy is beneficial for patients with advanced bladder cancer; however, trials generally exclude patients with comorbidities or uncommon histologies. The SAUL trial demonstrates that atezolizumab is safe and efficacious in a patient population that more accurately reflects the real-world scenario, but its benefit might still be limited in historically poorly performing populations.
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References
von der Maase, H. et al. Long-term survival results of a randomized trial comparing gemcitabine plus cisplatin, with methotrexate, vinblastine, doxorubicin, plus cisplatin in patients with bladder cancer. J. Clin. Oncol. 23, 4602–4608 (2005).
Dash, A. et al. Impact of renal impairment on eligibility for adjuvant cisplatin-based chemotherapy in patients with urothelial carcinoma of the bladder. Cancer 107, 506–513 (2006).
Balar, A. V. et al. Atezolizumab as first-line treatment in cisplatin-ineligible patients with locally advanced and metastatic urothelial carcinoma: a single-arm, multicentre, phase 2 trial. Lancet 389, 67–76 (2017).
Rosenberg, J. E. et al. Atezolizumab in patients with locally advanced and metastatic urothelial carcinoma who have progressed following treatment with platinum-based chemotherapy: a single-arm, multicentre, phase 2 trial. Lancet 387, 1909–1920 (2016).
Powles, T. et al. Atezolizumab versus chemotherapy in patients with platinum-treated locally advanced or metastatic urothelial carcinoma (IMvigor211): a multicentre, open-label, phase 3 randomised controlled trial. Lancet 391, 748–757 (2018).
Sternberg, C. N. et al. Primary results from SAUL, a multinational single-arm safety study of atezolizumab therapy for locally advanced or metastatic urothelial or nonurothelial carcinoma of the urinary tract. Eur. Urol. https://doi.org/10.1016/j.eururo.2019.03.015 (2019).
Johnson, D. B., Sullivan, R. J. & Menzies, A. M. Immune checkpoint inhibitors in challenging populations. Cancer 123, 1904–1911 (2017).
Tumeh, P. C. et al. Liver metastasis and treatment outcome with anti-PD-1 monoclonal antibody in patients with melanoma and NSCLC. Cancer Immunol. Res. 5, 417–424 (2017).
Goldberg, S. B. et al. Pembrolizumab for patients with melanoma or non-small-cell lung cancer and untreated brain metastases: early analysis of a non-randomised, open-label, phase 2 trial. Lancet Oncol. 17, 976–983 (2016).
U.S. Food and Drug Administration. FDA in brief: FDA takes new steps to broaden patient participation in cancer clinical trials, advancing policies to promote inclusion of pediatric patients and patients with medical conditions that can occur alongside cancer. FDA https://www.fda.gov/NewsEvents/Newsroom/FDAInBrief/ucm633202.htm (2019).
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D.P.P. declares grant support and/or consultant fees from Ada Cap (Advanced Accelerator Applications), Amgen, Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Clovis, Eli Lilly, Endocyte, Exelixis, Genentech, Incyte, Innocrin, Janssen, MedImmune, Merck, Novartis, Pfizer, Pharmacyclics, Progenics, Roche Laboratories, Sanofi Aventis, Seattle Genetics, and Urogen. T.F.S declares no competing interests.
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Stewart, T.F., Petrylak, D.P. Atezolizumab in understudied populations with bladder cancer. Nat Rev Urol 16, 449–450 (2019). https://doi.org/10.1038/s41585-019-0200-8
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DOI: https://doi.org/10.1038/s41585-019-0200-8