Unfortunately, enfortumab vedotin and pembro is the new reference standard of care in first line. Unfortunately, we don’t have biomarkers. We had the opportunity to try to test by immunohistochemistry the expression of Nectin-4, but it doesn’t really, or the data that we have are not really consistent in between prospective retrospective data. So we need to know more about the biology and the action of these novel antibody drug conjugates...
Unfortunately, enfortumab vedotin and pembro is the new reference standard of care in first line. Unfortunately, we don’t have biomarkers. We had the opportunity to try to test by immunohistochemistry the expression of Nectin-4, but it doesn’t really, or the data that we have are not really consistent in between prospective retrospective data. So we need to know more about the biology and the action of these novel antibody drug conjugates. Maybe new biomarkers in the field, trying to see if the patient’s tumor is more sensitive or not to the payload. Maybe it could be the driver. New trials with HER2 ADCs are up and running. Let’s see if this can be a good biomarker in the future. PD-L1 is not, it’s just prognostic. We need to know more about the biomarkers field. We need to do better in the patient selection. So today we have only clinical factors. And the clinical factors are mostly based on the performance status of the patients or mostly based on the histology, urothelial versus not urothelial variant histologies, and also based on the expected toxicities of the new payload toxicities that we can expect in our patients. So, well, we need to do better in trying to select and tailor the systemic treatment of patients in first-line metastatic urothelial cancer.
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