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Exploring the Role of Biomarkers in Patient Selection for Immunotherapy in Bladder Cancer

Shilpa Gupta, MD
Published Online:6:20 PM, Mon June 10, 2019

Shilpa Gupta, MD, assistant professor of medicine, Hematology/Oncology and Transplantation Division, University of Minnesota, discusses the current role of immunotherapy in treating patients with bladder cancer and how biomarkers have become an unmet need.

Although immunotherapy options have been an improvement since there weren’t any new therapies added to the bladder cancer treatment paradigm for the last 40 years in this population, says Gupta, only 20% to 25% of patients respond to immunotherapy. Biomarkers, however, can identify patients that can be spared the risk of disease progression and financial toxicities by determining earlier on the patients that likely will not respond to single-agent checkpoint inhibitors. Gupta urges that we need to do a better job going forward at finding the patients who likely will or will not respond.

However, there is currently not a clear picture for which biomarker should be used for patient selection in bladder cancer. PD-L1 status has not been as strong a biomarker as physicians hoped, and tumor mutational burden still requires more validation itself. Gupta says in the future, she believes multiple biomarkers may need to join together to get a composite sense of which patients with bladder cancer will respond to immunotherapy.
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