ESMO 2025 | Evolving standards in first-line metastatic urothelial cancer
Enrique Grande, MD, MD Anderson Cancer Center Madrid, Madrid, Spain, discusses the current standard of care for patients with first-line metastatic urothelial cancer, highlighting that while enfortumab vedotin and pembrolizumab is standard of care, access and reimbursement issues limit its availability in many countries, resulting in platinum-based chemotherapy remaining the standard of care. Whilst the JAVELIN Bladder 100 trial (NCT02603432) showed that patients who benefit from platinum-based chemotherapy can maintain this benefit with maintenance therapy, the DISCUS trial (NCT06892860) will assess whether the number of cycles of platinum-based chemotherapy can be reduced before offering maintenance therapy without impacting efficacy. This interview took place at the European Society for Medical Oncology (ESMO) 2025 Congress in Berlin, Germany.
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Transcript
You know now in enfortumab vedotin and pembro is the new reference systemic treatment for patients with first-line metastatic urothelial cancer. But that has been proved recently. In the majority of the countries still today, because of the access and reimbursement issues, we don’t have access to receive EVP, to offer EVP to the most of our patients. So still platinum-based chemotherapy that we have been using for decades are still considered the standard of care in many places across the country...
You know now in enfortumab vedotin and pembro is the new reference systemic treatment for patients with first-line metastatic urothelial cancer. But that has been proved recently. In the majority of the countries still today, because of the access and reimbursement issues, we don’t have access to receive EVP, to offer EVP to the most of our patients. So still platinum-based chemotherapy that we have been using for decades are still considered the standard of care in many places across the country. The JAVELIN Bladder 100 teaches that those patients who receive benefit from platinum-based chemotherapy could maintain this benefit impacting in the overall survival when we were offering available maintenance so in the DISCUS trial we had a clinical question that still needs to be addressed can we diminish the number of cycles of platinum-based chemotherapy before offering available maintenance to our patients trying to impact in the quality of life without a detrimental activity this is what we try to show at the trial.
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