Atezolizumab Bladder Cancer Indication Withdrawn in US Atezolizumab Bladder Cancer Indication Withdrawn in US

Atezolizumab (Tecentriq) is no longer approved in the United States for use in certain patients with bladder or urinary tract cancer.

The drug is an anti-PD-L1 inhibitor immunotherapy, and continues to be approved for use in lung and liver cancer and melanoma.

The manufacturer, Genentech, announced that it was voluntarily withdrawing the US indication for atezolizumab that covered its use in  adults with locally advanced or metastatic urothelial carcinoma (bladder cancer) who are not eligible for cisplatin-containing chemotherapy and whose tumors express PD-L1 or are not eligible for any platinum-containing chemotherapy regardless of PD-L1 status. 

The company said that it made the decision after consultation with the US Food and Drug Administration (FDA).

“While we are disappointed with this withdrawal, we understand the need to uphold the principles of the FDA’s Accelerated Approval Program, which brings innovative medicines to patients sooner,” said Levi Garraway, MD, PhD, Genentech chief medical officer and head of Global Product Development.

Atezolizumab had been granted an accelerated approval for this indication back in 2016, based on response rate data from the  IMvigor210 trial.

The company was obliged to conduct a follow-up trial to show clinical benefit, and launched IMvigor130, which it described as “the designated postmarketing requirement (PMR) to convert the accelerated approval to regular approval.”

The bladder cancer indication for atezolizumab was discussed (alongside several other indications for different immunotherapy drugs)  at a historic 3-day meeting of the FDA’s oncologic Drugs Advisory Committee in April 2021. At the time, ODAC voted 10-1 in favor of maintaining the indication for atezolizumab for the first-line treatment of cisplatin-ineligible patients with advanced/metastatic urothelial carcinoma, pending final overall survival results from the IMvigor130 trial.

Genentech has now said that this trial “did not meet the co-primary endpoint of overall survival (OS) for atezolizumab plus chemotherapy compared with chemotherapy alone” when used for the first-line treatment of patients with previously untreated advanced bladder cancer.

These data will be presented at an upcoming medical meeting, the company added.

“There is a considerable unmet need for effective and tolerable treatments for people living with advanced bladder cancer and so we regret that the IMvigor130 trial did not cross the statistical threshold for overall survival,” Garraway commented. 

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