Warning Stalled Immunotherapy Takeover in Bladder Cancer

The FDA's May 2018 warning against prescribing immunotherapy alone in bladder cancer patients with low PD-L1 expression quickly reversed the surge in use of these agents as first-line therapy, according to a new analysis.

In unadjusted numbers, immune checkpoint inhibitor use in first-line decreased from 51.9% prior to the agency's warning to 30.3% half a year later, while rates of platinum-based chemotherapy use increased from 37.0% to 60.6% during this time, reported Ravi Parikh, MD, MPP, of the Abramson Cancer Center at the University of Pennsylvania in Philadelphia, and colleagues.

Meanwhile, PD-L1 testing to guide first-line treatment more than doubled, going from 9.3% before a June 2018 label change to 21.2% by January 2019, as described in JAMA.

"Given the rapid expansion of approvals for immunotherapies, understanding how oncologists react to post-approval safety concerns is crucial, and our study suggests uptake of these changing recommendations can occur very quickly," Parikh said in a statement.