Metastatic Urothelial Carcinoma: Unmet Needs and Future Directions

Expert reflection on the current unmet needs in metastatic urothelial carcinoma and hope for future improvements in the treatment armamentarium.


Ignacio Durán, MD, PhD: The greatest unmet needs in bladder cancer could be summarized in 1 word: biomarkers. We are missing good biomarkers that help us select treatment. This is highly needed. That would help us a lot to guide treatment selection. The only targeted treatment that we have in advanced bladder cancer right now is a family of FGFR inhibitors that are indicated in patients who have alterations in their GFR [glomerular filtration rate]. Other than that, we’re guessing too much when we deliver treatment for our patients with metastatic bladder cancer. Predictive biomarkers of response is, to me, the highest unmet need.

In terms of the most promising data coming up, we’re all very excited about new combos. One combo that’s generated more expectation is the combination of the antibody-drug conjugate enfortumab vedotin [Padcev] plus pembrolizumab [Keytruda]. This combo already demonstrated a very high rate of response in a small group of patients with metastatic urothelial carcinoma who were cisplatin unfit. Based on those data, a randomized phase 3 study has been launched and is ongoing, and we’re participating. It’s recruiting very quickly. It compares enfortumab vedotin [Padcev] plus pembrolizumab [Keytruda] vs chemotherapy in first-line metastatic urothelial carcinoma, including cisplatin-eligible and cisplatin-ineligible patients. This combination could probably change the way we treat bladder cancer for the first time in the last 4 years.

Transcript edited for clarity.

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