Say what you want about 2017, but at least it brought us hope for a non-platinum treatment option for bladder cancers. Last month’s Lancet pub reports results of the phase 3 IMvigor211 trial that randomized almost 1K patients with platinum-refractory advanced urothelial carcinoma to standard chemo versus atezolizumab (PD-L1 inhibitor). Hey, if it works for platinum-refractory non-small cell lung cancer, why wouldn’t it for bladder cancer? Not sure why, but it didn’t. The primary endpoint of overall survival was same--11 months--for both treatment arms, but atezolizumab did result in half the rates of grade 3-4 toxicity and treatment discontinuations. PD-L1 inhibition may not be a panacea for all things malignant, but this data invigorates our short list of relatively non-toxic treatment alternatives for platinum-refractory bladder cancer.


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