Understanding Adjuvant Therapy in Bladder Cancer

Nivolumab (Opdivo), a PD-1-targeted immune checkpoint inhibitor, has demonstrated improvements in disease-free survival among patients with muscle invasive bladder cancer postsurgery. However, how doctors make treatment decisions in real-world settings between nivolumab and standard chemotherapy remains unclear.

A real-world analysis conducted by Alex Chehrazi-Raffle, MD, genitourinary medical oncologist at City of Hope Comprehensive Cancer Center in Duarte, California, and colleagues compared the characteristics of patients with bladder cancer who received nivolumab and those who received chemotherapy after surgery. The analysis showed that patients receiving nivolumab tended to have a worse ECOG performance status score, indicating poorer overall health. These findings revealed that patient health significantly influences treatment choices in bladder cancer.

In the interview, Chehrazi-Raffle discussed the study presented in a poster at the 2024 American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium.

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0:05 | One of the key findings from the study was that there appears to be a practice emphasis on patients who have higher-stage disease getting adjuvant nivolumab compared with adjuvant chemotherapy, so that is going to be patients with stage IIIB.

0:26 | Why that is important is because these are typically patients who are a little bit sicker, a little bit frailer, and not as eligible or fit for chemotherapy, so that was a big finding from this study. Another aspect was that [in] the study, we had a much higher proportion of Black and Hispanic patients that were included in CheckMate 274. What we saw was even practice patterns across all different types of racial and ethnic minorities, so more representative of the real-world setting.