SUO 2020: New Paradigms in NMIBC: The Evolving Role of Checkpoint Inhibition
(UroToday.com) The Society of Urologic Oncology (SUO) 2020 virtual meeting featured a session examining the new and emerging agents in bladder cancer chaired by Dr. Neal Shore, which included a presentation by Dr. Ashish Kamat discussing the evolving role of checkpoint inhibition in nonmuscle-invasive bladder cancer (NMIBC).
Dr. Kamat notes that Bacillus Calmette Guerin (BCG) is the original cancer immunotherapy with urologists administering approximately 1.2 million doses of BCG for bladder cancer. However, there are BCG failures, with ~30% failing at 1 year, and ~40% failing at 2-3 years after induction therapy. Classification of BCG failure is as follows:
SUO 2020: Next Generation Clinical Trial Design BCG-Unresponsive NMIBC
(UroToday.com) There have been several recent single-arm trials in the Bacillus Calmette-Guerin (BCG) unresponsive non-muscle invasive bladder cancer (NMIBC) setting (Table 1).
The first question that arises is whether these single-arm trials are enough or do we need to randomize patients for our future trials. As seen in Table 1, these treatments are given for a minimum of two years, requiring a high number of physician visits during these treatment years. To get more accurate information, we may need to consider randomizing these patients in the long run and compare these treatments head to head before making any informed decisions.