Novità in tema di carcinoma della
vescica
Marco MARUZZO
UOC Oncologia Medica 1
Dip. Oncologia Clinica e Sperimentale Istituto Oncologico Veneto, IOV IRCCS, Padova
Regione del Veneto
Agenda
Natural history and epidemiology
Patterns of care
Perioperative treatments
Adjuvant treatments
Treatments for metastatic disease
2016 news: have we moved the bar?
Incidence by age and probability aged-based
Galsky, JGO 2014
Taylor, JA Nat Clin Pract Urol 2009
Patterns of care
Booth, Urol Oncol 2014
Perioperative treatments
Grossman, NEJM 2003
Perioperative treatments: News in 2016
GU Symposium 2016, abs 365
A Randomized Phase II Study of CO-eXpression ExtrapolatioN (COXEN)-Directed Neoadjuvant Chemotherapy for Localized, Muscle-Invasive Bladder Cancer
Adjuvant treaments
Adjuvant treaments: 2016 news
GU Symposium 2016, abs 356
No significant differences in DFS across the study arms, but chemo arm was not originally planned, the statistical
assumptions are unclear
A RCT comparing adj RT vs Chemo plus RT vs Chemo alone after Cx
Adjuvant treaments: 2016 news
A Study of Adjuvant Nivolumab Versus Placebo Post-Surgical Removal of High Risk Invasive Urothelial Carcinoma (CheckMate 274)
Treatment with nivolumab will extend disease-free survival, compared with placebo, as adjuvant
therapy in all randomized patients and in patients with PD-L1 expressing tumors with high risk residual disease after radical resection of MIBC.
Metastatic disease: patterns of care
Porter, Urol Oncol 2009
Metastatic disease treatment 1L
von der Maase, JCO 2005
Metastatic disease: cisplatin unfit pts
Galsky, JCO 2011 De Santis, JCO 2011
Metastatic disease treatment 2L
Bellmunt, JCO 2009
Metastatic disease: immunotheraphy is here!
Atezolizumab in platium-treated mUC (1)
Atezolizumab in platium-treated mUC (2)
Atezolizumab in platium-treated mUC (3)
Atezolizumab in platium-treated mUC: safety
Atezolizumab in platinum-unift mUC (1)
Atezolizumab in platinum-unift mUC (2)
Atezolizumab in platinum-unift mUC (3)
Nivolumab in mUC (1)
Nivolumab in mUC (2)
Nivolumab in mUC (3)
Nivolumab in mUC (4)
Nivolumab in mUC (5)
Pembrolizumab in mUC (1)
Pembrolizumab in mUC (2)
Avelumab in mUC (1)
Avelumab in mUC (1)
Darvalumab in mUC (1)
Darvalumab in mUC (2)
Darvalumab in mUC (3)
Have we moved the bar?
Presented By Elizabeth Plimack at 2016 ASCO Annual Meeting
Post platinum ORR
Presented By Elizabeth Plimack at 2016 ASCO Annual Meeting
Front line therapy for cisplatin-unfit patients
Presented By Elizabeth Plimack at 2016 ASCO Annual Meeting
Progression outside of the target lesions
Take home messages
• Atezolizumab: 2016 new standard of care in mUC
• If you respond, you tend to continue doing it
• Well tolerated drug
• Even PD-L1 “low” patients can respond
• For clisplatin unfit patients, atezolizumab performs well
• Early development for nivolumab and darvalumab
• Need for phase III trials and comparative trials vs chemotherapy
• Which IT drug to use and in which sequence?
• Open questions: optimal duration? biomarkers?
Conclusions: moving the bar
Neo-adj Adjuvant M+ 1L M+ 2L M+ >2L
MVAC Cis-base CT MVAC Vinflunina Paclitaxel
Cis-Gem Cis-Gem
Carbo-Gem*
Up to now
Neo-adj Adjuvant M+ 1L M+ 2L M+ >2L
MVAC Cis-base CT MVAC Atezolizumab Vinflunina Cis-Gem (Chemo+RT) Cis-Gem (Nivolumab) Paclitaxel
(Nivolumab) Carbo-Gem*
(Atezolizumab)
2016 news
Future development in UC
marco.maruzzo@ioveneto.it
