Recent advances in immuno‐oncology and its application to urological cancers

Abstract

Recent advances in immuno-oncology have the potential to transform the practice of medical oncology. Antibodies directed against negative regulators of T-cell function (checkpoint inhibitors), engineered cell therapies and innate immune stimulators, such as oncolytic viruses, are effective in a wide range of cancers. Immune'based therapies have had a clinically meaningful impact on the treatment of advanced melanoma, and the lessons regarding use of single agents and combinations in melanoma may be applicable to the treatment of urological cancers. Checkpoint inhibitors, cytokine therapy and therapeutic vaccines are already showing promise in urothelial bladder cancer, renal cell carcinoma and prostate cancer. Critical areas of future immuno-oncology research include the prospective identification of patients who will respond to current immune-based cancer therapies and the identification of new therapeutic agents that promote immune priming in tumours, and increase the rate of durable clinical responses.

Biomarker classification, validation, and what to look for in 2017 and beyond

“…Continuing this theme into immunology, Mataraza and Gotwals reviewed the current status of immunotherapy in urological cancers. Durable responses to immunotherapy in metastatic melanoma have revolutionised this approach to cancer therapy, but as stated, there remains a significant challenge in finding biomarkers to predict responses (some of these drugs have moderate‐to‐severe toxicity risk), as well as combined therapies to combat drug resistance.…”

“… A BMJ case report discussed around the topic of simple biomarker nomenclature and classification . A comprehensive review of urinary biomarkers for bladder cancer . A validation study of a biomarker linked to sunitinib response in metastatic clear cell renal cancer . A review of immunotherapy in urological cancers . Two companion reviews of biomarker validation in immunotherapy . …”

Immune checkpoint blockade – a treatment for urological cancers?

“…Patients with metastatic malignant melanoma who were treated with ipilimumab had a median survival of 11 months; however, 22% of patients survived for ≥3 years with a plateau in the survival curve and in a subset of patients up to 10 years [3]. This success has not yet been replicated in prostate cancer [4]. In a more recent clinical trial involving patients with melanoma who progressed, nivolumab showed survival benefit of 72% at 1 year as compared with 42% with dacarbazine [5].…”

Immunotherapy in urological malignancies: can you take your knowledge to the next level?

“…. I urge you to start with the review article and give it a full line‐by‐line read. You may need to pull out pen and paper, and practice spelling and pronouncing a number of new compounds.…”

“…predictive vs prognostic), and the USA Food and Drug Administration (FDA) has approved such a biomarker for nivolumab response. However, even this story line is perplexing, as drug response is not always linked to the marker, and immune cell expression may be ‘inducible and dynamic’ .…”