Opinion|Videos|March 19, 2025
Adjuvant Anti–PD-1 Decision-Making: PD-L1 Expression, Residual Disease, and Variant Histologies
Author(s)Matthew Galsky, MD
An expert discusses how enthusiasm for adjuvant anti–PD-1 therapy varies based on key factors. Receipt of neoadjuvant chemotherapy (NAC), nodal involvement, positive margins, variant histology, and PD-L1 expression influence recommendations. Observation may be preferred in frail, elderly, or autoimmune-prone patients. muscle-invasive urothelial carcinoma (MIBC) status is critical in decision-making.
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Video content above is prompted by the following:
- Does your enthusiasm about recommending adjuvant anti–PD-1 differ based on the following variables?
- Receipt of NAC vs not
- Nodal involvement on original imaging and/or at surgery in final path
- Positive surgical margin
- Variant histologies (squamous, plasmacytoid, micropapillary, sarcomatoid, etc)
- PD-L1 expression
- What patient specific factors influence your decision to observe/monitor, rather than treat, your patients with >pT2 or ≥ypT2 stage and/or pN+ (eg, prior autoimmune disease, frailty, age)?
- MIBC vs not
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