Manojkumar Bupathi, MD, MS, medical oncologist, Rocky Mountain Cancer Centers, discusses the evolving treatment landscape of bladder cancer.

Although unmet needs exist in bladder cancer, the integration of maintenance therapy has improved survival outcomes for patients, Bupathi says. However, it remains unknown why some patients do not derive sufficient responses to available therapy. As such, improved treatment options are needed for this patient subgroup.

Utilizing genomic analyses and targeted therapy is promising in this patient population, Bupathi explains. Recent data from ongoing clinical trials have also demonstrated promise. For example, during the 2021 ESMO Congress, findings from the phase 2 NORSE trial (NCT03473743) demonstrated clinically meaningful responses with erdafitinib (Balversa) plus cetrelimab in patients with 

-altered, metastatic or locally advanced urothelial carcinoma.

Findings from the ongoing phase 1/2 EV-103 trial (NCT03288545) demonstrated frontline activity with the antibody-drug conjugate enfortumab vedotin-ejfv (Padcev) in combination with pembrolizumab (Keytruda) in patients with locally advanced or metastatic urothelial carcinoma. Moreover, the combination of sEphB4-HSA and pembrolizumab demonstrated synergistic activity and tolerability in patients with previously treated metastatic bladder cancer, according to findings from an ongoing phase 2 trial (NCT02717156).

Investigational targeted therapies have also demonstrated encouraging efficacy in patients with bladder cancer. Ultimately, understanding the tumor biology of bladder cancer and identifying more specific targets will further advance this paradigm, Bupathi concludes.

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Manojkumar Bupathi, MD, MS, discusses the evolving treatment landscape of bladder cancer.  



Dr. Bupathi on the Evolving Treatment Landscape of Bladder Cancer 

Manojkumar Bupathi, MD, MS, medical oncologist, Rocky Mountain Cancer Centers, discusses considerations for second-line treatment sequencing in clear cell renal cell carcinoma (RCC).

A main consideration in sequencing therapy for patients with RCC is knowing what prior treatment the patient received in the first-line setting, as this informs how they should be treated in the second-line setting, Bupathi says. For example, if a patient received pembrolizumab (Keytruda) plus lenvatinib (Lenvima) in the first-line setting, they should not receive lenvatinib in the second-line setting. Likewise, if a patient received cabozantinib (Cabometyx) plus nivolumab (Opdivo) in the first-line setting, they should not receive cabozantinib in the second-line setting and require an alternative regimen, Bupathi explains.

Sequencing is becoming more challenging because clinicians do not have all of the necessary data to make informed decisions and several second-line drugs have been moved into the frontline setting, Bupathi concludes.

Manojkumar Bupathi, MD, MS, discusses considerations for second-line treatment sequencing in clear cell renal cell carcinoma. 


Dr. Bupathi on Considerations for Second-Line Sequencing in RCC 

Manojkumar Bupathi, MD, MS, medical oncologist, Rocky Mountain Cancer Centers, discusses the improvement in first-line treatment options for patients with clear cell renal cell carcinoma (RCC). 

Three studies have demonstrated the efficacy of novel treatment options for patients with clear cell RCC in the first-line setting compared with traditional drugs like (Sutent) or pazopanib (Votrient), according to Bupathi. 

For example, the phase 3 CheckMate-9ER trial (NCT03141177) enrolled patients with previously untreated, advanced or metastatic RCC, and randomized them to receive either cabozantinib (Cabometyx) plus nivolumab (Opdivo) or sunitinib. Additionally, the phase 2 CABOSUN trial (NCT01835158) compared the use of cabozantinib vs sunitinib in patients with locally advanced or metastatic disease. Finally, the phase 3 CheckMate-214 trial (NCT02231749) enrolled patients with intermediate or poor-risk disease and compared the use of a doublet immunotherapy regimen comprised of nivolumab plus ipilimumab (Yervoy) vs sunitinib.

When navigating among these available options, it is important to consider risk stratification, possible associated toxicities, and whether a patient has symptomatic disease, Bupathi explains. Furthermore, comorbidities can help guide clinical decisions in this population, Bupathi concludes.

Manojkumar Bupathi, MD, MS, discusses the improvement in first-line treatment options for patients with clear cell renal cell carcinoma. 

Manojkumar Bupathi, MD, MS

Articles

Dr. Bupathi on the Evolving Treatment Landscape of Bladder Cancer

Dr. Bupathi on Considerations for Second-Line Sequencing in RCC

Dr. Bupathi on First-Line Treatment Options for Clear Cell RCC