Navigating Treatment Choices in Urothelial Cancer

Guru P. Sonpavde, MD, medical director, Genitourinary (GU) Oncology, assistant director, the Clinical Research Unit, the Christopher K. Glanz Chair, Bladder Cancer Research, AdventHealth Cancer Institute, provides insights on the phase 3 CheckMate 901 trial (NCT03036098) and explains what a community oncologist should know about the use of concurrent frontline nivolumab (Opdivo) plus chemotherapy in metastatic or unresectable urothelial carcinoma based on this study.

According to results of this phase 3 study that were presented at the 2023 ESMO Congress, patients who received nivolumab with the chemotherapy regimen had statistically significant improvements in overall survival (OS) and progression-free survival (PFS). With chemotherapy alone, the median OS was 18.9 months (95% CI, 14.7-22.4). This increased to 21.7 months (95% CI, 18.6-26.4) with the combination, translating to a 22% reduction in the risk of death (HR, 0.78; 95% CI, 0.63-0.96; P = .0171). Furthermore, the OS benefit observed with the nivolumab regimen was seen across all subgroups.

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0:09 | I think that community oncologists have a choice of different regimens now. We have the [gemcitabine, cisplatin, and nivolumab] regimen now in cisplatin-eligible patients. Again, I'm gonna think about it, like I said, that patients with lymph node-only disease, but also have a higher chance of enjoying a [complete response] with [gemcitabine and cisplatin], maybe that's where you should really think about [gemcitabine, cisplatin, and nivolumab].

0:31 | The EV [enfortumab vedotin; Padcev]/pembrolizumab regimen, of course, made a big splash at [the ESMO 2023] meeting with a median survival of 31.5 months overall. This was a group that had cisplatin-eligible and ineligible patients. I think that there are pros and cons to both, but clearly, I think that both regimens need to be discussed with the cisplatin-eligible patients. There are different toxicity concerns with [gemcitabine, cisplatin, and nivolumab] and EV/pembrolizumab, so all of these could be discussed with patients to make a well informed decision.