GU Cancers 2019 | The evolving treatment landscape for urothelial cancer

I think that as we sort of look to the future, in terms of how we manage urothelial cancer, there’s obviously a lot of studies that are currently going on which may ultimately shape the first line space for patients with metastatic disease, and so that may ultimately change the landscape. But in those patients who end up progressing after main checkpoint inhibitors, we obviously need new therapies. And there is several therapies that look very exciting. We also acknowledge the fact that not all patients respond to immune checkpoint inhibitors, so those agents, obviously, are also potentially applied to that patient population as well. And so, we can molecularly select patients and Dr. Siefker-Radtke had presented data, not here, but at ASCO in an oral presentation on Erdafitinib. And that looks like a particularly active agent in patients who harbor FGFR-alterations as a pan-FGFR inhibitor.

In afordamavidodin, which was presented at poster at this meeting, also demonstrated very exciting activity. This is a Nektinfor antibody-drug conjugate to Monomethyl Auristatin-E. And demonstrates response rates in about 40% of patients. And also in those patients that are previously treated with a checkpoint inhibitor, as well as in patients with visceral metastatic disease. There was also data with Ramucirumab and Docetaxel in the range trial, which demonstrated a small but statistically significant progression-free survival benefit. And there was a presentation by Dr. Tom Powles looking at the exposure-response relationship, to try to see whether or not there are particularly a group of patients who may do better based on pharmacokinetics as related to the overall survival, secondary outcome in this study.

And they did demonstrate that using minimum concentration at cycle two, day one may predict for those patient who have a greater likelihood of achieving a longer survival outcome.