481 656
Other studies with a similar design (3-arm trials with
OS PFS) as the primary endpoint) are comparing chemo-
therapy versus chemotherapy with ICIs versus IC alone using
either pembrolizumab (NCT02853305) or atezolizumab
(NCT02807636).
Finally, clinical testing of ICIs in UC is being broadened.
Two trials are testing atezolizumab (NCT02450331) and
nivolumab (NCT02632409) in the adjuvant setting. In
addition, studies innon–muscle-invasive disease have begun.
Together, these may change the entire UC clinical pathway.
8.
Summary
Overall, this is an exciting time for the UC field.
Atezolizumab was established in 2016 as a new standard
of care in for some UC patients in some countries. There are
positive randomised data for pembrolizumab in the
platinum-refractory setting. As new combinations are
tested earlier in the disease course, long-term remission
may become a reality for a significant proportion of
patients. There is a need to ensure that our understanding
of how the drugs work keeps pace with the speed of drug
development so that we do not reach a premature plateau.
Therefore, biomarkers studies should run in parallel with
randomised trials. Combination trials should ideally be
randomised. For the first time in a generation there is light
at the end of the tunnel for patients with metastatic UC.
Conflicts of interest:
Tom Powles has received honoraria/research
funding from Bristol-Myers Squibb, Roche, AstraZeneca, and Merck.
Arnulf Stenzl has received honoraria/research funding fromBayer, Bristol-
Myers Squibb, Immatics, Novartis, Merck, Pfizer, and Roche. Jens Bedke
has received honoraria/research funding from AstraZeneca, Bristol-Myers
Squibb, Novartis, Pfizer, and Roche. Kate Smith has nothing to disclose.
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