Unlocking the Potential of Erdafitinib in Bladder Cancer Treatment

Arlene O. Siefker-Radtke, MD, professor of genitourinary medical oncology at the University of Texas MD Anderson Cancer Center in Houston, Texas, discusses the latest breakthroughs in bladder cancer treatment with erdafitinib (Balversa), an FGFR1-4 inhibitor.

The agent was recently approved by the FDA for the treatment of locally advanced or metastatic urothelial carcinoma with FGFR3 alterations with disease progression following a prior line of treatment. The approval was supported by findings from the THOR study (NCT03390504).

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0:09 | At the moment, there are not any planned trials in the metastatic setting, however, erdafitinib is being explored in earlier-stage disease. When we look at metastatic tumors of the bladder, we see FGF alterations in 15% to 20% of patients. And in metastatic tumors of the upper tract, we see FGF alterations in over 35% of patients. When we move to earlier-stage disease, that superficial bladder cancer, we see FGF alterations in over 60% of patients. So using erdafitinib, we might be able to control or help delay recurrences and patients with superficial bladder cancer needing transurethral resection.

1:02 | At this year's ESMO meeting, we saw some first results from a randomized trial in superficial bladder cancer which compared erdafitinib vs alternative care, and it showed that erdafitinib had benefit, but it came at the cost of toxicity, [adverse] effects like hand-foot syndrome, or the risk of central serous retinopathy, which an earlier-stage disease where patients can be cured with cystectomy, most patients chose not to continue on the erdafitinib.

1:37 | However, to overcome that, there are now drug-eluting stents, so a drug-eluting pretzel, that can be placed inside the bladder, eluting erdafitinib into the bladder, creating more sustained erdafitinib levels without the systemic toxicity. I really do have high hopes for these pretzel-like structures that you can put inside the bladder, these drug-eluting strategies, which will allow us to get treatment where it is needed into that superficial urothelium without having all of those [adverse] effects of systemic therapy.