Managing High-Risk NMIBC
Transcript: Neal Shore on ICIs and chemo in NMIBC
Dr. Neal Shore
Interview recorded February 2025. All transcripts are created from interview footage and directly reflect the content of the interview at the time. The content is that of the speaker and is not adjusted by Medthority.
Our colleagues at HCRN, which do fabulous work, they presented some early phase data of combining durvalumab systemic therapy as a checkpoint inhibitor with intravesical gemcitabine and docetaxel. I think that's a really interesting abstract. Again, early data, no new safety signals that you would not expect from either of these therapeutics. Some additional work from our colleagues in China looking at intravesical gemcitabine and docetaxel with another checkpoint inhibitor, tislelizumab, which is not approved in the US, but there are a lot of checkpoint inhibitors, PD blockers, that are being investigated. So I think that world is very fascinating, because there can be some adaptive potential, synergistic immunologic response. We're always trying to, you know, when we look at these early phase studies, measure the side effect profile assuredly, but look for a sort of a proof of concept signal that could, you know, delay recurrence and assuredly minimised the risk of progression. There's another phase 2 study that was presented using intra-arterial chemotherapy, which is something I've not had experience with, with also with BCG and atezolizumab in high-risk NMIBC. That's taking a certainly more proactive, some might argue, a slightly more aggressive approach. But, you know, we do have patients with high-risk NMIBC, and if one looks at the EAU risk stratification, we have those with very high-risk, you know, those with variant subpopulations on their histopathology, volume of disease, lymphovascular invasion.
So that's a particular subpopulation that, you know, we need to be thinking how we could be potentially a little bit more aggressive in a good way, more proactive way to not only cut down on their much greater risk of recurrence, but an increased risk of progression. Which leads to a whole cascade of other systemic therapies or intravesical therapies for unresponsive disease, and even arguably, moving quicker to having a cystectomy.
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