ASCO 2025 | What are the best second-line treatment options in urothelial carcinoma?
Whilst enfortumab vedotin and pembrolizumab have been established as the first-line standard of care in metastatic urothelial carcinoma, second-line treatment options are less clear. Jacqueline Brown, MD, Emory University School of Medicine, Atlanta, GA, comments on the current challenges in sequencing second-line treatments for patients in this setting. Current options include various platinum doublet chemotherapies and erdafitinib for patients with FGFR3 mutations, but sequencing these treatments to minimize neuropathy is a significant challenge. This interview took place during the 2025 American Society of Clinical Oncology (ASCO) Meeting in Chicago, IL.
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Transcript
We’ve definitely had the creation of this vacuum in the second-line setting. And what should we be using now? Right now, the order of it is a little bit of dealer’s choice. So we have platinum doublet chemotherapy. We have biomarker-selected agents like erdafitinib for FGFR3 mutations. We have in HER2 for HER2-positive patients. We don’t know how to sequence them...
We’ve definitely had the creation of this vacuum in the second-line setting. And what should we be using now? Right now, the order of it is a little bit of dealer’s choice. So we have platinum doublet chemotherapy. We have biomarker-selected agents like erdafitinib for FGFR3 mutations. We have in HER2 for HER2-positive patients. We don’t know how to sequence them. I think it’s really important that for a lot of our patients who receive EV Pembro in the first-line setting, we’re going to be dealing with some degree of neuropathy left over from those patients. So how do we sequence these drugs like platinum thereafter and not exacerbate those problems that we have? So it’s space open to be ordered right now. I hope we can figure it out, but it’s the wild, wild west at the current time.
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