Bladder Cancer

The FDA has added PD-L1 status to the labels for pembrolizumab (Keytruda) and atezolizumab (Tecentriq) for existing frontline approvals for platinum-ineligible patients with urothelial carcinoma. The addition was made based on lower overall survival rates with the PD-1/PD-L1 inhibitors compared with platinum-based chemotherapy for patients with PD-L1–low expressing platinum-eligible urothelial carcinoma.

Arlene O. Siefker-Radtke, MD, professor of genitourinary medical oncology at MD Anderson Cancer Center, discusses the results presented at the 2018 ASCO Annual Meeting from a phase II cohort investigating erdafitinib in previously treated patients with urothelial cancer. Erdafitinib is a fibroblast growth factor receptor (FGFR) inhibitor that targets FGFR 1 through 4 and has previously shown promising activity. 

According to a phase II study, over 40% of patients with metastatic or unresectable urothelial carcinoma responded to treatment with the investigational fibroblast growth factor receptor (FGFR) inhibitor erdafitinib. Findings from this study were presented at the 2018 ASCO Annual Meeting.

Sumanta K. Pal, MD, associate professor of the Department of Medical Oncology and Experimental Therapeutics at City of Hope, discusses the data he considers when treating patients with metastatic urothelial carcinoma.

Daniel P. Petrylak, MD, a professor of Medicine and Urology and co-director of the Signal Transduction Research Program at Yale School of Medicine, discussed results from the phase III RANGE trial for the combination of ramucirumab (Cyramza) and docetaxel in patients with urothelial carcinoma.

Cisplatin-based neoadjuvant chemotherapy followed by radical cystectomy has been the standard of care in muscle-invasive bladder cancer for almost 2 decades. However, the rates of NAC utilization remain low and many patients are ineligible to receive cisplatin due to diminished renal function or other factors. Additionally, there are no reliable biomarkers routinely used in clinical practice that identify patients most likely to benefit from NAC, and limited prospective comparisons of the NAC regimens.

According to results from the phase III POUT trial, adjuvant platinum-based chemotherapy improved disease-free survival and metastasis-free survival in patients with upper tract urothelial carcinoma. These results indicated that adjuvant platinum-based chemotherapy could be a new standard of care for UTUC, investigators said.

Ani S. Balmanoukian, MD, discusses immunotherapy developments in GU malignancies