Transforming Care in Advanced Urothelial Cancer with Immunotherapy: Frequently Asked Questions
CPC Released: 23-04-2021
Valid for credit through: 23-04-2022
Duration: 30 minutes
The treatment landscape for patients with advanced urothelial cancer (UC) has been transformed by the addition of immune checkpoint inhibitors (ICIs). However, integrating these immunotherapy options into daily practice may be challenging. View experts from five European countries addressing frequently asked questions in the management of advanced UC and gain their insights on the latest treatment advances and the optimal use of novel immunotherapies to maximize patient outcomes. An accompanying country-specific evidence-based reference slide deck is available to view and download.
Thomas Powles, MD, MRCP, MBBS
St Bartholomew’s Cancer Centre
ThomThomas Powles is Professor of Genitourinary Oncology and Director of Barts Cancer Centre in London, UK. He trained in medical oncology at Imperial College London, UK, and completed his post-graduate training in oncology in 2005, receiving an MD from the University of London in 2006, with a thesis on the mechanisms of resistance to therapy in urological cancers. Prof. Powles is the lead for solid tumor research at Barts Cancer Institute, London, leading a spectrum of clinical trials across phase I–III, including biomarker, novel targeted, and immune therapies studies. He is the author of over 300 peer-reviewed publications in all the major medical journals. Prof. Powles participates in, or leads, a number of guidelines committees.
Ignacio Durán, MD, PhD
Marqués de Valdecilla University Hospital
Ignacio Durán MD, PhD currently works at the Medical Oncology Department of the Hospital Universitario “Marques de Valdecilla” in Santander, Spain, where he leads the Genitourinary (GU) Oncology Program and, since 2018, has also coordinated the clinical and translational research unit.
He earned his medical degree in 1997 from the Universidad de Salamanca and his PhD in 2005 from the Universidad Complutense de Madrid, with the highest commendation. He completed his training as a medical resident in medical oncology at Hospital Universitario Son Dureta in Palma de Mallorca and, subsequently, completed a Fellowship in Drug Development and GU Oncology at the Princess Margaret Hospital in Toronto, Canada.
Dr Durán has been involved in setting up GU Oncology Programs with special emphasis on patient care and clinical research. Alongside, he has been highly involved in medical education by developing learning programs in both the pre- and post-graduate setting and by mentoring a number of trainees – national and international and at different levels of their academic careers. He has also actively collaborated in educational activities promoted by national and international groups. As a researcher, his major interests are clinical research in the area of GU oncology and anticancer clinical drug development, along with medical education and team management. He has authored numerous publications in scientific journals with important contributions concerning different GU malignancies; he has also led or participated in more than 120 clinical trials.
Moreover, Dr Durán has received awards such as the ASCO Foundation Merit Award and the University Health Network Outstanding Research Presentation Award. He is a member of the European Society for Medical Oncology (ESMO), European Association of Urology (EAU), and the Spanish Society of Medical Oncology (SEOM). He has served on the board of directors of the Spanish Society of Research in Cancer (ASEICA) since January 2021.
Viktor Grünwald, MD, PhD
University Hospital Essen (AöR)
West-German Cancer Center Essen | Clinic for Medical Oncology and Clinic for Urology
Viktor Grünwald, MD, PhD is Professor of Interdisciplinary Genitourinary Oncology at the University Hospital Essen, Essen, Germany, where he specializes in medical oncology. His core research interests are genitourinary cancers, soft tissue sarcomas, and head and neck cancers, with an emphasis on academic drug development and translational research of immunotherapies in these areas. Professor Grünwald graduated from Hannover Medical School, Hannover, Germany, in 1998, after which he was appointed as a Private Lecturer and, subsequently, Professor of Hematology and Oncology at the same institution. Professor Grünwald has served as a member of the scientific committee for a number of symposia and congresses and has chaired many different working groups in academic organizations.
Yohann Loriot, MD, PhD
Yohann Loriot MD, PhD was appointed as Senior Lecturer and Consultant in Medical Oncology at Gustave Roussy, Villejuif, France, in 2013. He works in clinical drug development within genitourinary trials and has a particular interest in rationally designed molecular targeted therapies and immunotherapies in urothelial and bladder cancer. Dr Loriot graduated from the University of Paris in 2009 and completed a PhD in 2014. He was awarded a travelling scholarship and pursued further research at the Vancouver Prostate Cancer Centre in Vancouver, Canada. Dr Loriot received the prestigious ASCO Conquer Foundation Young Investigator Award in 2014. Over the last 5 years, Dr Loriot has been involved in the development of multiple novel agents, many of which are now approved drugs, and he is currently running over 20 clinical trials. Dr Loriot is currently a member of the steering committees of multiple international clinical trials from phase I to phase III, and a co-author of collaborative work, published in N Engl J Med, Nature, Lancet Oncology, European Urology, and J Clin Oncol. He has been involved in trials leading to several drug approvals (enzalutamide, abiraterone, atezolizumab, erdafitinib). Dr Loriot’s major research focus involves the study of molecular mechanisms mediating progression to lethal disease in bladder and prostate cancer and the use of this information to develop novel new strategies and therapies.
Andrea Necchi, MD
Vita-Salute San Raffaele University
IRCCS San Raffaele Hospital and Scientific Institute
Professor Andrea Necchi, MD is a Medical Oncologist specializing in the treatment of urological malignancies. He received his medical degree from the University of Milan, Italy, and subsequently completed a post-doctoral specialization in medical oncology at the same university. After completing his clinical training, he worked at the Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. In November 2020, he was appointed as Associate Professor of Oncology at Vita-Salute San Raffaele University and Director of Genitourinary Medical Oncology at IRCCS San Raffaele Hospital and Scientific Institute in Milan, Italy. Professor Necchi is fully dedicated to the treatment of genitourinary malignancies; his research team is focused on the entire spectrum of urological malignancies and is primarily devoted to the development of clinical trials with new experimental therapies, in all trial phases. In particular, his recent work focused on the development of perioperative strategies aimed at delivering new therapies combined with radical surgery in early-stage, operable disease. He currently serves as a board member of the European Association of Urology (EAU) Research Foundation and an associate member of the American Society of Clinical Oncology (ASCO)-EAU penile cancer guidelines panel. He is Principal Investigator of several academic phase I–II trials of immuno-oncology combinations in urological malignancies. Professor Necchi was the first recipient of the ‘Gianni Bonadonna Prize for New Drug Development in Oncology’ and has earned four Merit Awards from the Conquer Cancer Foundation of ASCO.
- How big a problem is locally advanced or metastatic bladder cancer in your country?
- How often are atypical histologies seen, and what impact do they have on prognosis and treatment principles?
- What proportion of your patients are fit enough for cisplatin-based first-line chemotherapy?
- How do you assess fitness for cisplatin-based chemotherapy?
- What were the designs and findings from IMvigor 210 and KEYNOTE 052 studies for cisplatin-ineligible patients?
- How have these results affected first-line therapy for cisplatin-ineligible patients in your own practice and in your country in general?
- What barriers are there to more widespread use?
- What are the trial data with immune checkpoint inhibitors in patients deemed fit for cisplatin?
- What were the design and key findings from the JAVELIN Bladder 100 trial of maintenance avelumab?
- Have these trial results had an impact on clinical practice in your country yet?
- What information do we have on other ICIs as a maintenance strategy?
New strategies and future developments
- Where are we regarding the use of combination strategies in the first-line setting?
- What do we know about the role of neoadjuvant immunotherapy?
- When do you use neoadjuvant therapy in your practice?
- How do you see adjuvant and first-line therapies developing over the next 1–2 years?
- How important is PD-L1 positivity in patient selection for treatment with ICIs?
- How are you treating patients in the second-line setting in your practice, and what are your national guidelines?
- What do you recommend as second-line treatment for patients pre-treated with ICIs in either the first-line or maintenance settings?
- How do you see novel treatments such as enfortumab vedotin, sacituzumab govitecan and erdafitinib being integrated into clinical care in the future?
- Is pseudo-progression ever an issue for patients with urothelial bladder cancer, and does it influence your treatment recommendations?
Adverse event management
- What are the major adverse event challenges in the use of ICIs when treating patients who have urothelial bladder cancer?
- How has COVID-19 impacted on your treatment strategy with ICIs and management of adverse events?
This educational activity is specifically designed for medical oncologists, urologists, and other healthcare professionals involved or interested in the management of urothelial carcinoma.
Upon completion of this educational activity, participants should be able to:
- Describe the current treatment roles and the regulatory landscape of immunotherapy in advanced/metastatic urothelial cancer
- Discuss efficacy and safety evidence surrounding the use of immune checkpoint inhibitors and antibody-drug conjugates for advanced/metastatic urothelial cancer
- Integrate immunotherapeutics into treatment plans for advanced/metastatic urothelial cancer
- Develop strategies to manage adverse events associated with immunotherapy for advanced/metastatic urothelial cancer
Provided by ACE Oncology.
This educational activity is supported by an independent grant from Pfizer, and the Healthcare business of Merck KGaA, Darmstadt, Germany.
The Faculty of Pharmaceutical Medicine has approved this event/course for CPD and allocated it 0.25 continuing professional development credits (CPD).
The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interest related to the content of this activity:
Thomas Powles has served as an advisor or consultant for AstraZenea, BMS, Exelixis, Incyte, Ipsen, Merck, MSD, Novartis, Pfizer, Seattle Genetics, Merck Serono, Astellas, Johnson & Johnson, Eisai, and Roche. He has received grants for clinical research from Astra Zeneca, BMS, Exelixis, Ipsen, Merck, MSD, Novartis, Pfizer, Seattle Genetics, Merck Serono, Astellas, Johnson & Johnson, Eisai, and Roche. He has received travel/accommodation/expenses from Roche, Pfizer, MSD, AstraZeneca, and Ipsen. Any labeled/unapproved uses of drugs or products referenced in his presentation will be specified.
Ignacio Durán has served as an advisor or consultant for Astellas, MSD, Roche, BMS, Merck, and AstraZeneca. He has served as a speaker or a member of a speakers bureau for Janssen, Astellas, BMS, and AstraZeneca. He has received grants for clinical research from Roche, and AstraZeneca. Any labeled/unapproved uses of drugs and products referenced in his presentation will be specified.
Viktor Grünwald has served as an advisor or consultant for AstraZeneca, BMS, MSD, EUSA Pharma, Ipsen, Merck-Serono, Novartis, Eisai, Roche, and Bayer. He has received grants for clinical research from Novartis, BMS, MSD, AstraZeneca, and Ipsen. He owns stock, stock options, or bonds from AstraZeneca, BMS, MSD, Seattle Genetics, and Genmab. Any labeled/unapproved uses of drugs or products referenced in his presentation will be specified.
Yohann Loriot has served as an advisor or consultant for Astellas, Pfizer, Merck, MSD, Janssen, Immunomedics, Seattle Genetics, Taiho, BMS, AstraZeneca, and Roche. Any labeled/unapproved uses of drugs and products referenced in his presentation will be specified.
Andrea Necchi has served as an advisor or consultant for Merck, Roche, Bayer, AstraZeneca, Clovis Oncology, Janssen, Incyte, Seattle Genetics/Astellas, Bristol-Myers Squibb, Rainier Therapeutics, Glaxo Smith Kline (GSK), and Ferring. He has received grants for clinical research from Merck, AstraZeneca, and Ipsen. Any labeled/unapproved uses of drugs or products referenced in his presentation will be specified.
The employees of ACE Oncology have disclosed:
Robert Coleman is the Chair of Inbiomotion Scientific and Clinical Advisory Board. He receives consulting fees for advising on clinical trial protocol development from Amgen, Astellas, and Boehringer Ingelheim; he has intellectual property rights as co-inventor and patent holder of biomarker under development by Inbiomotion; he gives independent medical education lectures at symposia supported by Amgen, Eisai, and Genomic Health; and has received travel expenses from Amgen for presentation of clinical trial data at ASCO 2018 conference.
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