Role of Immune Checkpoint Inhibitors in Locally Advanced or Metastatic Bladder Cancer: The Urologist's Perspective

Activity Details
  • Credit Amounts:
    • CME: 1.50
    • Other: 1.50
  • Cost: Free
  • Release: Jul 20, 2017
  • Expires: Jul 20, 2018
  • Estimated Time to Complete:
    1 Hour(s)  30 Minutes
  • System Requirements:
  • Average User Rating:
    ( Ratings)


 This activity has 4 faculty members associated with it.
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Joaquim Bellmunt Joaquim Bellmunt, MD, PhD
Associate Professor of Medicine
Harvard Medical School
Director, Bladder Cancer Center
Dana-Farber Cancer Institute
Boston, MA

Colin P.  Dinney Colin P. Dinney, MD
Professor and Chairman
Department of Urology
University of Texas MD Anderson Cancer Center
Houston, TX

Robert Dreicer Robert Dreicer, MD, MS, MACP, FASCO
Associate Director for Clinical Research
Deputy Director, University of Virginia Cancer Center
Section Head, Medical Oncology
Co-Director, Paul Mellon Urologic Cancer Institute
Professor of Medicine and Urology
University of Virginia School of Medicine
Charlottesville, Virginia

Ashish Kamat Ashish Kamat, MD, MBBS, FACS
Professor, Department of Urology
Wayne B. Duddlesten Professor of Cancer Research
Associate Cancer Center Director, RFHNH, Mumbai
University of Texas MD Anderson Cancer Center
Houston, Texas

Needs Statement

Urothelial bladder cancer (UBC) accounts for >90% of all bladder cancers and is the ninth most common cancer worldwide.1,2 The prognosis for patients with UBC who relapse after cisplatin-containing chemotherapy is poor. With no established standard of care, a median overall survival of ~15 months and a 5-year survival rate of ≤15%, relapsed UBC represents a substantial unmet medical need.3,4

Although the role of immunotherapy was first established in UBC more than 40 years ago, no systemic immunotherapy was available for patients with advanced/metastatic UBC who have progressed on platinum-containing regimens until the recent approval of immune checkpoint inhibitors (ICIs) that target a programmed cell death protein 1 (PD-1) or one of its ligands (PD-L1).5,6 Other ICIs investigated in UBC include those that target cytotoxic T-lymphocyte-associated protein 4 (CTLA-4).7 Based on the promising results in metastatic disease, most of these ICIs are under development in high-risk non-metastatic disease as well. Moreover, in addition to combining ICIs with cytotoxic chemotherapy, radiation, or targeted therapy, a promising strategy for enhancing the immune response is to combine anti–PD-1/PD-L1 and anti–CTLA-4 therapy with each other or with novel immune checkpoints (e.g., those targeting OX40, LAG3, and TIM3).

While these recent developments with ICIs in mUBC have and will continue to change the treatment paradigm in UBC, the future studies will likely identify biomarkers that can predict therapeutic efficacy and extend clinical benefit to more patients.     

1Fleshner NE, et al. Cancer. 1996. 2 International WCRF. Worldwide Data (2012). 3Antoni S, et al. Eur Urol. 2017. 4Massard C, et al. J Clin Oncol. 2016. 5Sharma P, et al. Lancet Oncol. 2017. 6Rosenberg JE, et al. Lancet. 2016. 7Gupta S, et al. Cancers (Basel).2017.

Target Audience

This activity is designed to meet the educational needs of urologists and oncologists.


At the conclusion of this activity, participants will be able to:

1. Describe the basic concepts of cancer immunotherapy, including intravesical immunotherapy and systemic immune checkpoint blockade, and rationale for its use in bladder cancer.

2. Appraise safety and efficacy of current and emerging cancer immunotherapy, including immune checkpoint inhibitors, in patients with locally advanced or metastatic bladder cancer.

3. Evaluate the role for biomarkers in locally advanced or metastatic bladder cancer when immune checkpoint inhibitors are used.

4. Identify practical strategies to prevent, anticipate, and manage immune-related adverse events in patients with locally advanced or metastatic bladder cancer in your urology practice.



In support of improving patient care, Creative Educational Concepts is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

CEC designates this enduring material for a maximum of 1.50 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

ACGME Competencies

  • Patient care
  • Medical knowledge

IOM Competencies

  • Provide patient-centered care
  • Employ evidence-based practice

Creative Educational Concepts, Inc. certifies this activity for 1.50 hours of participation.

Faculty Disclosure

Planner and Faculty Disclosures

In accordance with the Food and Drug Administration, the speakers have disclosed that there is the potential for discussions concerning off-label uses of a commercial product/device during this educational activity.

Any person who may contribute to the content of this continuing education activity must disclose relevant relationships (and any known relationships of their spouse/partner) with commercial interests whose products or services are discussed in educational presentations. A commercial interest is defined as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Relevant relationships include receiving from a commercial interest research grants, consultant fees, travel, other benefits, or having a self-managed equity interest in a company.

Disclosure of a relationship is not intended to suggest or condone any bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation.

Vanessa Carranza, PharmD - has no relevant financial relationships to disclose in relation to the content of this activity.

Joan B. Fowler, PharmD, BCPP - has no relevant financial relationships to disclose in relation to the content of this activity.

Joaquim Bellmunt, MD, PhD - has disclosed that he is a consultant for AstraZeneca, Genentech, and Merck and receives grant/research support from Novartis and Sanofi.

Colin P.N. Dinney, MD - has disclosed that he receives financial or material support from FKD Therapies.

Robert Dreicer, MD, MS, MACP, FASCO - has disclosed that he is a consultant for Asana, Astellas, AstraZeneca, Bristol-Myers Squibb, Eisai, Exelixis, Medivation, Roche, and Sanofi-Genzyme. He also receives grant/research support from Asana, Genentech, and Merck.

Ashish M. Kamat, MD, MBBS, FACS - has disclosed that he is a consultant for Abbott Molecular, Cepheid, Heat Biologics, Merck, OncoGeneX, Photocure, Sanofi, Spectrum Pharmaceuticals, Telesta Therapeutics, and Therelase. He also receives grant/research support from FKD Therapies, Heat Biologics, Merck, and Photocure.


Activity Instructions

Media: Internet Web Activity (Powerpoint slides and audio)


To receive a statement of credit, you must:

  • Read the target audience, learning objectives, and author disclosures.
  • Review the full content of the activity and reflect upon its teaching.
  • Complete the questions and evaluation at the end of the activity.
  • You must have a passing score of 70% on the post-test. You will have two (2) opportunities to complete the post-test.