Dr Mike Lattanzi: Bladder Cancer Novel Therapies and Investigational Studies

Mike Lattanzi, MD, genitourinary medical oncologist at Texas Oncology, participated in 2 recent studies on bladder cancer.

You were a coauthor on a paper published last year on treating patients with Tecentriq and chemotherapy before surgery in muscle-invasive bladder cancer. Can you discuss these findings?

I was fortunate enough to be part of a large group effort of an investigator-initiated trial led by Sam Funt[, MD, urologic oncologist] and Jonathan Rosenberg[, MD, chief of the Genitourinary Oncology Service] at Memorial Sloan Kettering Cancer Center using combination platinum-based chemotherapy with gemciatbine and cisplatin with the addition of the PD-L1 antibody and atezolizumab for patients with muscle invasive urothelial cancer.

The study was a positive trial and hit the primary end point of pathologic downstaging, which we achieved in over half of patients. And we look further to additional combinations of immunotherapy in the neoadjuvant setting.

You've also explored the impact of human epidermal growth factor recepter (HER) alterations in bladder cancer. What are the treatment options in this area?

Bladder cancer actually has the highest rate of all HER2 alterations among the solid tumors. That includes, of course, both driver mutations, as well as genomic amplification. And there's increasing interest in the use of novel HER2-targeting antibody-drug conjugates for this subset of patients.

However, further work remains to be done to identify the optimal biomarker to select patients for benefit from these novel her to antibody-drug conjugates. And it's not clear at this time, if IHC [immunohistochemistry] is the optimal biomarker, or if we should be looking at other things like amplification or mutation.