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Thomas Flaig, MD


Update on Managing Bladder Cancer: An Evolving Landscape

By: Julia Fiederlein
Posted: Thursday, June 9, 2022

“The landscape for the treatment of bladder cancer has changed remarkably and rapidly over the past several years,” commented Thomas W. Flaig, MD, Professor of Medicine and Vice Chancellor for Research, University of Colorado Anschutz Medical Campus, Aurora, and Chair of the NCCN panel for bladder cancer. The new treatment options and subsequent revisions to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) were discussed in detail in his presentation during the NCCN 2022 Virtual Annual Conference, highlights of which were published in JNCCN–Journal of the National Comprehensive Cancer Network.

“Immune checkpoint inhibitors have had a dramatic impact on the way we treat patients with bladder cancer,” Dr. Flaig commented.

The PD-1 inhibitor pembrolizumab was approved by the U.S. Food and Drug Administration in patients with high-risk Bacillus Calmette-Guérin–unresponsive non–muscle-invasive bladder cancer who are not pursuing surgery, which paved the way for integrating immune checkpoint inhibitor therapy in several new indications. Pembrolizumab is incorporated into the current NCCN Guidelines as the preferred regimen for patients with locally advanced or metastatic disease who underwent platinum-based chemotherapy.

Additionally, according to Dr. Flaig, new therapeutic options have emerged for advanced bladder cancer. Both the antibody-drug conjugate enfortumab vedotin-ejfv and the pan-FGFR tyrosine kinase inhibitor erdafitinib are incorporated into the current NCCN Guidelines as alternative preferred systemic therapies for the second-line setting of patients with locally advanced or metastatic disease who underwent chemotherapy; they are also the preferred subsequent-line regimens in this patient population.  

“Just think back to 2015, when nothing existed in the second line,” Dr. Flaig remarked. “We really have become quite sophisticated here.”

Disclosure: Dr. Flaig reported financial relationships with Aurora Oncology, Janssen, and Seattle Genetics.

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