The US FDA has limited the use of pembrolizumab and atezolizumab for patients with locally advanced or metastatic urothelial cancer who are not eligible for cisplatin-containing therapy.

The Agency took this action on June 19, 2018, due to decreased survival associated with the use of pembrolizumab or atezolizumab as single therapy (monotherapy) compared to platinum-based chemotherapy in clinical trials to treat patients with metastatic urothelial cancer who have not received prior therapy and who have low expression of the protein programmed death ligand 1 (PD-L1).

The labels of both drugs have been revised to reflect the limitation in the indication.

The indications read as follows:

Pembrolizumab is indicated for the treatment of patients with locally advanced or metastatic urothelial carcinoma who are not eligible for cisplatin-containing therapy and whose tumors express PD-L1 (Combined Positive Score ≥ 10), or in patients who are not eligible for any platinum-containing chemotherapy regardless of PD-L1 status.

Atezolizumab is indicated for the treatment of patients with locally advanced or metastatic urothelial carcinoma who are not eligible for cisplatin-containing therapy, and whose tumours express PD-L1 (PD-L1 stained tumour-infiltrating immune cells [IC] covering ≥5% of the tumour area), as determined by an FDA-approved test, or are not eligible for any platinum-containing therapy regardless of PD-L1 status.

On July 2, 2018, the FDA approved the Ventana PD-L1 (SP142) Assay (Ventana Medical Systems, Inc.) for PD‑L1 expression in ≥ 5% IC in urothelial carcinoma tissue.

The test should be used to select patients with locally advanced or metastatic urothelial carcinoma for treatment with atezolizumab.

The FDA also updated the Prescribing Information for Tecentriq to require use of an FDA-approved test for patient selection.

The tests used in the trial to determine PD-L1 expression are listed in Section 14 of each drug label.

The FDA is reviewing the findings of ongoing analyses and will communicate new information regarding the PD-L1 assays and indications as it becomes available.

Click here for prescribing information for pembrolizumab and atezolizumab.

Source: FDA