Posted: Monday, April 24, 2023
“We are getting closer to [optimizing a] targeted, personalized therapy for our patients with bladder cancer,” said Arlene O. Siefker-Radtke, MD, of The University of Texas MD Anderson Cancer Center, Houston, during her presentation on the safety and efficacy of emerging targeted therapies at the NCCN 2023 Annual Conference in Orlando, Florida. Platinum-based chemotherapy, although demonstrating favorable efficacy outcomes, also requires careful monitoring when used for bladder cancer. Therefore, a combination of targeted and immunotherapeutic agents may have the potential to outperform platinum-based chemotherapy and change the standard of care in this clinical context.
Dr. Siefker-Radtke began by discussing enfortumab vedotin-ejfv. The phase III EV-301 trial demonstrated improved survival outcomes when compared with chemotherapy in patients who received a prior platinum-containing chemotherapy regimen. Enfortumab vedotin targets Nectin-4, which is expressed in more than 80% of patient samples and thus is not required to test for prior to treatment. “This is certainly a treatment that is now here to stay; however, there is toxicity,” Dr. Siefker-Radtke commented.
Toxicity was also shown to be associated with erdafitinib, the first biomarker-directed therapy to be approved for metastatic urothelial carcinoma, and the targeted therapy sacituzumab govitecan-hziy. Clinicians should be aware of the many side effects of these treatments, so patients may be treated and monitored accordingly. “We do not yet have a truly nontoxic therapy,” Dr. Siefker-Radtke acknowledged.
Combining targeted therapies with immunotherapy has been a source of excitement for many clinicians treating patients with bladder cancer. Erdafitinib plus the monoclonal antibody cetrelimab has demonstrated antitumor activity in metastatic urothelial cancer. However, data from cohort 3 in the TROPHY-U-01 trial showed a lower objective response rate with sacituzumab govitecan-hziy plus pembrolizumab. “Perhaps eradication of lymphocytes is resulting in the lack of additive to synergistic benefit,” Dr. Sieker-Radtke noted.
Disclosure: For full disclosures of Dr. Siefker-Radtke, visit nccn.digitellinc.com.