Current and Future Trends in the Bladder Cancer Treatment Paradigm

Matthew Galsky, MD, professor of medicine and director of genitourinary medical oncology at Mount Sinai, and codirector of the Center of Excellence for Bladder Cancer and associate director for translational research at the Tisch Cancer Institute, discusses the future of bladder cancer research and the introduction of new treatments.

According to Galsky, chemotherapy used to be the only treatment option for urothelial cancer, and there were few chemotherapies available such as cisplatin and carboplatin. More recently, new drugs have been approved for treatment, including immune checkpoint inhibitors, antibody-drug conjugates, and combination therapies.

Single-arm phase 1 studies led to the approval of immune checkpoint inhibitors in urothelial carcinoma, including nivolumab (Opdivo) and pembrolizumab (Keytruda), which were both approved by the FDA in 2017 for locally advanced and metastatic disease. These provide new options for patients who cannot receive platinum-based chemotherapy or have platinum-resistant disease. Enfortumab vedotin (Pacdev), an antibody-drug conjugate, received FDA approval in 2021 for patients who progressed after receiving platinum-based chemotherapy and an immune checkpoint inhibitor.

Galsky anticipates that the future of the urothelial cancer setting will be determining the best ways to apply the currently available treatments based on individual patient conditions. Developing new drugs with greater efficacy and safety is also an important next step.

TRANSCRIPTION:

0:08 | The field has really exploded with a number of new treatment options for urothelial cancer. This is a field where for decades, we really only had chemotherapy, and really only had a few chemotherapy regimens, that were considered standard of care. And now we have a number of new approvals spanning different drug classes, spanning different clinical disease states of this disease. And so, a number of new treatments are available. Of course, the key is going to be to define how to best use the current treatments that we have to optimize individual outcomes for patients. And then of course, even with all of these advances, we still need better treatments, and we still need safer treatments, and so drug development in this disease remains a priority.