ESMO 2025 | Evolving treatment sequencing and options in advanced bladder cancer
Michiel Van der Heijden, MD, PhD, Netherlands Cancer Institute, Amsterdam, Netherlands, describes the evolving treatment landscape for bladder cancer. Immunotherapy may also be suitable for refractory patients who have received prior treatments such as enfortumab vedotin or chemotherapy in the neoadjuvant setting. New trials are necessary to determine the optimal sequence of therapies, including ADCs, targeted therapies like erdafitinib for FGFR3 mutated patients, and other emerging treatments. This interview took place at the European Society for Medical Oncology (ESMO) 2025 Congress in Berlin, Germany.
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Transcript
The treatment paradigm for perioperative therapy is rapidly changing. So we have enfortumab (vedotin) now available in many places in the world, but there’s also now studies coming out with EV plus IO in the perioperative space. We saw those at ESMO. So I think that we should see treatment for bladder cancer, a treatment continuum. So patients who recur usually recur already in the first year after surgery, which is now with these new treatment paradigms, the period when patients are still receiving adjuvant immunotherapy...
The treatment paradigm for perioperative therapy is rapidly changing. So we have enfortumab (vedotin) now available in many places in the world, but there’s also now studies coming out with EV plus IO in the perioperative space. We saw those at ESMO. So I think that we should see treatment for bladder cancer, a treatment continuum. So patients who recur usually recur already in the first year after surgery, which is now with these new treatment paradigms, the period when patients are still receiving adjuvant immunotherapy. So I think usually the majority of patients should be seen as immunotherapy refractory and have had either EV or chemotherapy as well in the neoadjuvant setting. So it means that you have to look for the treatments that haven’t been given yet in the perioperative space. So those would be the first choice. And of course, this is also becoming a setting where I think we should do new trials to see if new therapies could work. There’s a lot of ADCs in development, some other drugs as well. There’s also targeted therapy with Erdafitinib and FGFR3 mutated patients. So there’s some options, but we have to do the trials to find out what the best sequence would be.
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