So clearly the combination is beneficial to patients. I think one of the major questions is whether these combinations are synergistic. Are they actually generating more responses because we’re giving them simultaneously? Or are they sort of additive, meaning that we’re just giving two effective therapies? What we’re seeing in the field now is because PD-L1 inhibitors have become the standard of care for frontline metastatic bladder cancer, that we’re starting to see studies adding a third agent, for example, an FGFR inhibitor in phase three trials now to see if we can build on this backbone...
So clearly the combination is beneficial to patients. I think one of the major questions is whether these combinations are synergistic. Are they actually generating more responses because we’re giving them simultaneously? Or are they sort of additive, meaning that we’re just giving two effective therapies? What we’re seeing in the field now is because PD-L1 inhibitors have become the standard of care for frontline metastatic bladder cancer, that we’re starting to see studies adding a third agent, for example, an FGFR inhibitor in phase three trials now to see if we can build on this backbone. Hopefully we get better efficacy. The challenge is we might get more toxicity and there’s probably a balance between the two. Some patients may not need a third drug. They may be in that 30% of patients who are going to respond really well. Other patients clearly need it because they’re going to have progressive disease. So I don’t know that there’s an optimal combination for every patient. I think obviously better biomarkers will help us sort of re-stratify our patients and know who’s going to respond better. So it’s an exciting time to be in the field. We have so many new drugs and there’s so many ways to combine these that I think the next few years are going to be really exciting and great for patients.
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