ESMO 2022 | Treatment sequencing in patients with mUC who have relapsed on ICI
Enrique Grande, MD, PhD, MSc, MD Anderson Cancer Center Madrid, Madrid, Spain, explores treatment options for patients with metastatic urothelial carcinoma (mUC) who have not responded or relapsed following immune checkpoint inhibitor (ICI) therapy, touching on antibody-drug conjugates such as enfortumab vedotin which have demonstrated improved overall survival, progression-free survival and quality of life in the EV-301 study (NCT03474107). In addition, Dr Grande discusses FGFR targeting agents such as erdafitnib which has been approved in this patient population. This interview took place at the European Society for Medical Oncology (ESMO) 2022 Congress in Paris, France.
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Transcript (edited for clarity)
Well, now the sequencing strategy for a metastatic urothelial carcinoma not responding to platinum and immune checkpoint inhibitors, or who are ineligible to receive platinum and they are receiving immune checkpoint inhibitors, is becoming more and more important and challenges in daily practice. Why? Because we have more and more patients in this area.
Traditionally, we were treating these patients with chemotherapy, vinflunine, taxanes were mostly used in these setting so far...
Well, now the sequencing strategy for a metastatic urothelial carcinoma not responding to platinum and immune checkpoint inhibitors, or who are ineligible to receive platinum and they are receiving immune checkpoint inhibitors, is becoming more and more important and challenges in daily practice. Why? Because we have more and more patients in this area.
Traditionally, we were treating these patients with chemotherapy, vinflunine, taxanes were mostly used in these setting so far. However, now we have two different strategies to offer to our patients. Enfortumab vedotin, the antibody drug conjugates against nectin-4, I think it is the most robust and the highest level of evidence systemic treatment that we can offer in this setting. Enfortumab vedotin has demonstrated to be superior, to improve the overall survival, the response rate, the progression-free survival, and also the quality of life when compared in the EV-301 versus chemotherapy in this field.
We have another option, which are the fibroblast growth factor receptor inhibitors, particularly erdafitinib that are approved by the FDA, not yet by the EMA. We are still waiting for the third trial, the Phase III trial in this scenario. How we are approaching, how we are selecting patients in daily practice for this new systemic line of treatment? Well today, if the patient is fit enough to receive enfortumab because the toxicity of enfortumab needs to be balanced in this setting, don’t forget that these patients are heavily pretreated patients, so the quality of life, the toxicity expected with enfortumab needs to be balanced and taken into consideration in daily practice. Enfortumab should be the better approach or at least the most robust and highest level of evidence behind the use of enfortumab in this field. And, while probably chemotherapy is an option, if you don’t have access to enfortumab and the molecular testing to select patients FGFR-positive should be applied, should be used in daily practice, or at least will be needed to be used in daily practice shortly when we have the approval of erdafitinib in our environment.
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