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From clinical trials to real-life clinical practice: the role of immunotherapy with PD-1/PD-L1 inhibitors in advanced urothelial carcinoma

From clinical trials to real-life clinical practice: the role of immunotherapy with PD-1/PD-L1 inhibitors in advanced urothelial carcinoma
From clinical trials to real-life clinical practice: the role of immunotherapy with PD-1/PD-L1 inhibitors in advanced urothelial carcinoma
Context

A number of PD-1/PD-L1 inhibitors have recently been approved for use in patients with locally advanced or metastatic urothelial carcinoma (UC) on the basis of results from several clinical trials.

Objective

To review the evidence from these trials and consider what it means for the use of these drugs in first-line and post-platinum settings in real-life clinical practice.

Evidence acquisition

PubMed was searched for full reports of clinical trials of single-agent PD-1/PD-L1 inhibitors in advanced UC. Twelve publications were included.

Evidence synthesis

Responses to PD-1/PD-L1 inhibitors appear to be durable but are only achieved in 17–26% of patients. These drugs offer different toxicity and efficacy profiles to standard chemotherapy regimens. This should be considered when choosing a treatment strategy for each patient.

Conclusions

PD-1/PD-L1 inhibitors represent a major step forward in the management of advanced UC, although several questions remain regarding their optimal use in routine clinical practice. A validated predictive biomarker of response is yet to be defined, and this is perhaps the most significant unmet need for currently available drugs.

Patient summary

We reviewed the results from clinical trials that investigated how well certain types of anticancer drugs called PD-1/PD-L1 inhibitors worked in patients with bladder cancer. We found that more research is required to identify (1) the factors that might predict which patients with bladder cancer will respond to PD-1/PD-L1 inhibitors and (2) the optimum duration of treatment with these drugs.

Atezolizumab, Avelumab, Bladder cancer, Durvalumab, Immune checkpoint inhibitor, Immunotherapy, Nivolumab, Pembrolizumab, Transitional cell carcinoma, Urothelial carcinoma
486-500
Hussain, Syed A.
c08e606a-bf25-4672-b6d8-fa376e593b92
Birtle, Alison
1031c636-ab1a-4bc5-b053-5f1334c6c087
Crabb, Simon
bcd1b566-7677-4f81-8429-3ab0e85f8373
Huddart, Robert
9b98e268-407a-4dc5-85de-884cadb943a7
Small, Diane
74397967-0c01-4708-ae39-de8332b26d56
Summerhayes, Maxwell
6ec7d35b-1f70-46fc-9be9-8ee04c3acd65
Jones, Robert
8361d7a4-d225-4621-8e4b-9049573aebc9
Protheroe, Andrew
d08720c0-b773-4e6d-9d29-2341dce037a8
Hussain, Syed A.
c08e606a-bf25-4672-b6d8-fa376e593b92
Birtle, Alison
1031c636-ab1a-4bc5-b053-5f1334c6c087
Crabb, Simon
bcd1b566-7677-4f81-8429-3ab0e85f8373
Huddart, Robert
9b98e268-407a-4dc5-85de-884cadb943a7
Small, Diane
74397967-0c01-4708-ae39-de8332b26d56
Summerhayes, Maxwell
6ec7d35b-1f70-46fc-9be9-8ee04c3acd65
Jones, Robert
8361d7a4-d225-4621-8e4b-9049573aebc9
Protheroe, Andrew
d08720c0-b773-4e6d-9d29-2341dce037a8

Hussain, Syed A., Birtle, Alison, Crabb, Simon, Huddart, Robert, Small, Diane, Summerhayes, Maxwell, Jones, Robert and Protheroe, Andrew (2018) From clinical trials to real-life clinical practice: the role of immunotherapy with PD-1/PD-L1 inhibitors in advanced urothelial carcinoma. European Urology Oncology, 1 (6), 486-500. (doi:10.1016/j.euo.2018.05.011).

Record type: Review

Abstract

Context

A number of PD-1/PD-L1 inhibitors have recently been approved for use in patients with locally advanced or metastatic urothelial carcinoma (UC) on the basis of results from several clinical trials.

Objective

To review the evidence from these trials and consider what it means for the use of these drugs in first-line and post-platinum settings in real-life clinical practice.

Evidence acquisition

PubMed was searched for full reports of clinical trials of single-agent PD-1/PD-L1 inhibitors in advanced UC. Twelve publications were included.

Evidence synthesis

Responses to PD-1/PD-L1 inhibitors appear to be durable but are only achieved in 17–26% of patients. These drugs offer different toxicity and efficacy profiles to standard chemotherapy regimens. This should be considered when choosing a treatment strategy for each patient.

Conclusions

PD-1/PD-L1 inhibitors represent a major step forward in the management of advanced UC, although several questions remain regarding their optimal use in routine clinical practice. A validated predictive biomarker of response is yet to be defined, and this is perhaps the most significant unmet need for currently available drugs.

Patient summary

We reviewed the results from clinical trials that investigated how well certain types of anticancer drugs called PD-1/PD-L1 inhibitors worked in patients with bladder cancer. We found that more research is required to identify (1) the factors that might predict which patients with bladder cancer will respond to PD-1/PD-L1 inhibitors and (2) the optimum duration of treatment with these drugs.

Full text not available from this repository.

More information

Accepted/In Press date: 30 May 2018
e-pub ahead of print date: 2 July 2018
Published date: 1 December 2018
Keywords: Atezolizumab, Avelumab, Bladder cancer, Durvalumab, Immune checkpoint inhibitor, Immunotherapy, Nivolumab, Pembrolizumab, Transitional cell carcinoma, Urothelial carcinoma

Identifiers

Local EPrints ID: 432058
URI: http://eprints.soton.ac.uk/id/eprint/432058
PURE UUID: e54bf7ad-9242-49fc-8089-e82ef10e391c
ORCID for Simon Crabb: ORCID iD orcid.org/0000-0003-3521-9064

Catalogue record

Date deposited: 28 Jun 2019 16:30
Last modified: 18 Feb 2021 17:00

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Contributors

Author: Syed A. Hussain
Author: Alison Birtle
Author: Simon Crabb ORCID iD
Author: Robert Huddart
Author: Diane Small
Author: Maxwell Summerhayes
Author: Robert Jones
Author: Andrew Protheroe

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