The Landscape of Advanced Urothelial Carcinoma

A brief overview of the advanced urothelial carcinoma landscape encompassing disease course and standard of care treatment strategies.


Thomas Powles, MBBS, MRCP, MD: Metastatic or advanced urothelial cancer, which is often referred to as bladder cancer but involves the upper tract as well, is [lethal] for the vast majority of [patients who receive a diagnosis of the disease]. The reason it’s such a lethal disease is it tends to grow and spread very quickly. Actually, the median overall survival of this group of patients is somewhere between 12 and 14 months in the most recent randomized trials. The cancer tends to spread to the lymph nodes, the lungs, the liver, and the bones. The disease is usually diagnosed both with histology [and] also with cross-sectional imaging, CT scanning being the most common way of diagnosing the metastatic disease.

The disease unchecked, left to grow alone, would be devastating in the very short term. We’ve known for maybe 40 years now that chemotherapy is quite effective at getting initial control of disease. And that control is associated with a reduction in the size of the cancer but, sadly, resistance inevitably occurs in almost all patients, which is why we’ve gone on to develop a generation of immune therapies….Once patients have had first-line chemotherapy, second-line chemotherapy works less well, and for that reason, we’ve substituted immune therapy and other drugs such as antibody-drug conjugates and targeted therapies with FGFR [fibroblast growth factor receptors] inhibitors into that space instead.

Urothelial cancer is a top 10 cancer; it’s a frequent cancer. It’s strongly associated with smoking and exposures to some industrial components. Urothelial cancer is common in…men more than women and [individuals who] are older rather than younger, and the urothelial type is the commonest subtype. But there are other histological subtypes such as squamous cancers, which have other etiological factors and are common in other environments or other countries; Egypt, I think, has a very high incidence of squamous cancer.

Transcript edited for clarity.

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