Researchers from Mount Sinai and Sema4, a health information company and Mount Sinai venture, discovered that giving metastatic bladder cancer patients simultaneous chemotherapy and immunotherapy is safe and that patients whose tumors have certain genetic mutations may respond particularly well to this combination approach, according to the results of a clinical trial published in European Urology.
Though chemotherapy and immunotherapy have become standard options for the treatment of metastatic bladder cancer, it was previously unknown whether these therapies could be given together and whether chemotherapy’s side effect of weakening the immune system would inhibit immunotherapy.
The phase II trial was conducted at six cancer centers, and patients in the trial did not show any additional or more severe side effects than patients given chemotherapy or immunotherapy alone, a finding that showed the combination therapy is a safe alternative.
Researchers also generated evidence showing that immunotherapy could boost immune cells in the blood of patients receiving concurrent chemotherapy, allaying previous concerns that chemotherapy might counteract the effects of immunotherapy.
One of the new trials, which Matthew Galsky, director of genitourinary medical oncology and professor of urology, medicine, hematology and medical oncology at The Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai, and principal investigator of the study.
The study, headed by Galsky at Mount Sinai and other centers, gives chemotherapy and immunotherapy to a subset of patients with earlier-stage bladder cancer to determine if this combination can head off the need for surgery to remove the bladder, a standard treatment but one with quality-of-life-altering implications that include wearing a urostomy bag outside the body to collect urine. The other trial combines two different chemotherapy regimens with immunotherapy to determine the best types of chemotherapy drugs to combine with immunotherapy.
Galsky and Andrew Uzilov, director of cancer genomics for Sema4, and Huan Wang, Sema4 bioinformatics scientist, and other researchers hypothesized that patients with tumors with particular genetic mutations might respond best to the combination of chemotherapy and immunotherapy.
They found that certain types of mutations in DNA damage response genes were associated with better response to the combined chemotherapy and immunotherapy. If validated in subsequent studies, these findings could add a novel biomarker to the “precision oncology toolbox” and refine the selection of patients who might benefit from concurrent administration of chemotherapy and immunotherapy.
This study was supported by Bristol-Myers Squibb, Cancer Research Institute Clinical Strategy Team Grant, and National Cancer Institute grant P30 CA196521.
