Case 3: Mutational Patterns in Bladder Cancer

EXPERT PERSPECTIVE VIRTUAL TUMOR BOARD

Arlene O. Siefker-Radtke, MD:I see we’re moving even earlier in the disease space. And how do you feel about using FGFR inhibitors earlier? I know there are different frequencies where it’s detected across disease state.

Gordon Brown, DO:Yes. I believe it’s detecting up to 70% basically of patients who have bladder cancer. I think it will naturally evolve into a trial in that space. The questions really become toxicity versus benefit, as it will with all these therapies earlier on and being able to avoid radical cystectomy in that high-risk patient population.

I think that that is compelling that you published, and I think that if the responses continue to show the similar responses in a superficial population with less toxicity potentially, then it would be a very reasonable approach in patients with high-risk non-muscle-based disease.

Arlene O. Siefker-Radtke, MD:OK. So maybe a role in muscle-invasive disease. How about in urothelial tumors of different sites? Do you see any differences in mutation frequency, even in metastatic settings? Betsy?

Elizabeth R. Plimack, MD:Different sites like upper tract versus lower tract?

Arlene O. Siefker-Radtke, MD:Yes.

Elizabeth R. Plimack, MD:I think there have been a lot of studies looking at that. They’re powered somewhat but not comprehensively in my mind. I think while there may be a propensity to a different mutational pattern in one versus the other, we’re still in the clinic faced with defining that particular patient and determining what makes the most sense.

Tian Zhang, MD:There’s actually an interesting adjuvant study that’s led by Monty Pal, MD, and others looking at one of the FGFR inhibitors, infigratinib, for upper tract disease. And the thought is if we’re seeing moreFGFRmutations in the upper tract, then maybe these patients benefit more from adjuvant therapy early on as well. So that is an ongoing phase III, I think it’s randomized to placebo, trial for patients withFGFR-mutated or translocated upper tract urothelial cancers.

Transcript edited for clarity.