Letter to Editor

Precision Immuno-Oncology: How Can we Improve Responses to Immunotherapy in Bladder Cancer?

Kris Prado and Chin Arnold*
Department of Urology, Broad Stem Cell Research Center, and Jonsson Comprehensive Cancer Center, USA


*Corresponding author: Chin Arnold, Department of Urology, Broad Stem Cell Research Center, and Jonsson Comprehensive Cancer Center, USA

Published: 12 Oct, 2017
Cite this article as: Prado K, Arnold C. Precision Immuno- Oncology: How Can we Improve Responses to Immunotherapy in Bladder Cancer?. Clin Oncol. 2017; 2: 1355.

Letter to Editor

Immuno-Oncology has energized the oncology landscape, including in the treatment of bladder cancer. Validation of multiple combinational strategies and novel immune targets will be forthcoming. Current challenges in PD-1/PD-L1 checkpoint inhibition have been developing accurate biomarkers to predict response, as PD-L1 expression itself is an inaccurate indicator. Mutational load or burden is indicative of tumor immunogenicity and thus susceptibility to immunotherapy. Perhaps these parameters will be more predictive than PD-L1 expression. I Vigor 210 revealed higher response and survival rates to atezolizumabin patients with increased mutational burdens [1]. Furthermore, mismatch repair mechanisms can influence mutational load and mutation-associated neo-antigens, with evidence that patients with mismatch repair deficiencies are more sensitive to anti-PD-1 therapy across multiple cancer types [2]. Fundamental understanding and clinical evaluation of mismatch repair deficiency and mutational load will be imperative in moving forward with immunotherapy for muscle invasive bladder cancer.


References

  1. Balar AV, Galsky MD, Rosenberg JE, Powles T, Petrylak DP, Bellmunt J, et al. Atezolizumab as first-line treatment in cisplatin-ineligible patients with locally advanced and metastatic urothelial carcinoma: a singlearm, multicentre, phase 2 trial. Lancet. 2017;389(10064):67-76.
  2. Le DT, Durham JN, Smith KN, Wang H, Bartlett BR, Aulakh LK, et al. Mismatch-repair deficiency predicts response of solid tumors to PD-1 blockade. Science. 2017;357(6349):409-413.