ESMO 2021 | IMvigor011: atezolizumab for ctDNA-positive patients with high-risk muscle invasive bladder cancer

Thomas Powles, MBBS, MRCP, MD, Barts Cancer Institute, London, UK, explains the rationale of the IMvigor011 clinical trial (NCT02450331), which evaluates the efficacy atezolizumab versus placebo in patients with high-risk muscle invasive bladder cancer (MIBC) who are circulating tumour (ct)DNA-positive post-cystectomy. This Phase III study was based on results of the exploratory analysis of the IMvigor010 clinical trial (NCT02450331), which demonstrated that ctDNA was more accurate in predicting relapse than CT scans. In fact, ctDNA-positive patients had a 6-fold increased risk of relapse in comparison to ctDNA-negative patients. Importantly, this study reported that there was a 40% reduction in risk of death in patients receiving atezolizumab who were ctDNA-positive in comparison to patients receiving atezolizumab who were ctDNA-negative. Further analyses revealed that ctDNA-positive patients that responded well to anti-PD-L1 therapy had high PD-L1 and tumor mutational burden (TMB) at baseline. Prof. Powles explains that ctDNA appears to be a highly accurate method to identify a high-risk population that will benefit from early atezolizumab treatment, and hypothesizes that circulating biomarkers may replace radiology in the future. This interview took place at the European Society for Medical Oncology (ESMO) 2021 congress.