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Top Line: Does adjuvant immunotherapy improve outcomes for muscle-invasive urothelial carcinoma

The Study: Neoadjuvant, cisplatin-based chemo is the preferred for muscle invasive bladder cancer (MIBC). That’s because data is stronger for chemo is in the neoadjuvant rather than adjuvant setting. Immunotherapy plays an increasing role in the treatment of advanced bladder cancer. IMvigor010 is the first phase 3 trial to evaluate the role of adjuvant immunotherapy (in the form of atezolizumab) for patients with high risk urothelial carcinoma following surgery. Over 800 patients with mostly MIBC were randomized to no further therapy or atezolizumab for up to 1 year following radical surgery. Patients had to have high risk features such as ypT2-4a, pT3-4a, and pN+ disease. About half received neoadjuvant cisplatin-based chemo while the rest did not (and they had to have been ineligible for or declined adjuvant cisplatin-based chemo). Compared to observation, adjuvant atezo did not significantly improve median DFS (19.4 vs 16.6 months). In addition, there was more toxicity in the atezo arm (31% vs 18%). No key patient subgroups appeared to derive particular benefit from adjuvant atezo. Specifically, PD-L1 status and receipt (or not) of neoadjuvant chemo had no apparent influence on atezo benefit.

TBL: Adjuvant atezolizumab does not improve disease-free survival among patients with resected, high risk, muscle-invasive urothelial carcinoma. | Bellmunt, Lancet Oncol 2021

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