“Even with the current standard of care — surgery with or without pre-surgery chemotherapy —muscle-invasive urothelial carcinoma has a high risk of recurring.

These new findings show that treating patients at highest risk of recurrence with an immunotherapy after surgery can help extend the time until the disease returns,” said Robert Dreicer, MD, MS, MACP, FASCO, ASCO expert in genitourinary cancers.

Treatment with the immunotherapy nivolumab following radical surgery with or without cisplatin-based chemotherapy significantly improved disease-free survival in patients with muscle-invasive urothelial carcinoma, according to a study that will be presented at the 2021 ASCO Genitourinary Cancers Symposium, taking place virtually February 11-13.

The results come from the phase III CheckMate 274 trial of adjuvant nivolumab in patients who underwent radical surgery (surgery intended to remove all diseased tissue) for high-risk muscle-invasive urothelial carcinoma of the bladder, ureter, or renal pelvis.

Median disease-free survival—the time between the end of primary treatment and the return of signs or symptoms of cancer—was significantly longer for patients who received post-surgery treatment with nivolumab (median 21 months) compared with those who received placebo (median 10.9 months).

Disease-free survival for a subset of patients with tumours positive for a certain type of protein (PD-L1) was also improved with nivolumab (median, however, not yet reached by the time of analysis).

“Nivolumab is the first immune therapy to be used in the adjuvant setting that provides a statistically significant and clinically meaningful improvement in disease-free survival for patients with high-risk muscle-invasive urothelial carcinoma after radical surgery with curative intent, irrespective of PD-L1 status,” said lead author Dean F. Bajorin, MD, a medical oncologist at Memorial Sloan Kettering Cancer Center in New York.

The study involved 709 patients with muscle-invasive urothelial carcinoma of the bladder, ureter, or renal pelvis who underwent radical surgery with or without pre-surgery (neoadjuvant) cisplatin-based chemotherapy.

There was a high risk for recurrence based on the tumour stage at surgery. Patients were randomised to receive nivolumab or placebo every other week for 1 year.

Nivolumab is an immunotherapy that works by blocking the protein PD-L1 from binding to another protein (PD-1) found on T cells, which are part of the immune system. When PD-L1 and PD-1 bind, T cells are prevented from killing cancer cells. By blocking PD-L1, nivolumab allows T cells to kill cancer cells.

The standard-of-care treatment for muscle-invasive urothelial carcinoma is cisplatin-based neoadjuvant therapy followed by radical surgery — removal of the bladder.

However, some patients may be ineligible to receive cisplatin due to factors like inadequate kidney function. Adjuvant nivolumab could provide a treatment option for these patients to reduce the risk of recurrent cancers and death.

More serious treatment-related side effects (grade 3–4) were seen among patients who received nivolumab (17.9%) than those who received placebo (7.2%). The most common grade 3 or higher treatment-related side effects were diarrhoea, colitis, and pneumonitis in the nivolumab arm and colitis, diarrhoea, gamma-glutamyl transferase (GGT) increase, and hepatitis in the placebo arm.

In order to examine the impact of nivolumab on overall survival and cancer-specific survival, longer follow-up is needed.

Source: ASCO