Systemic treatment for advanced urothelial cancer: an update on recent clinical trials and current treatment options

Park, Inkeun; Lee, Jae‐Lyun

doi:10.3904/kjim.2020.204

Cited by 13 publications

(8 citation statements)

References 140 publications

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“…Treatment guidelines for la/mUC have been frequently updated 41 ; a recent study reported that providers followed current guidelines for decision-making in the la/mUC setting. 15 In the present study, approximately two-thirds of physicians identified institutional guidelines—especially the NCCN guidelines, which are considered the most up to date by US providers—as an important factor informing 1L treatment decisions.…”

Section: Discussionmentioning

confidence: 99%

Evaluating Oncologists’ Practice Patterns and Decision-Making in Locally Advanced or Metastatic Urothelial Carcinoma: The US Physician PARADIGM Study

Gupta,

Costantino,

Ike

et al. 2023

The Oncologist

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Background The treatment landscape for locally advanced/metastatic urothelial carcinoma (la/mUC) has evolved. This study examined US prescribing patterns and clinical decision-making for first-line (1L) and first-line maintenance (1LM) treatment. Materials and Methods US-based oncologists (N = 150) completed an online survey on patient demographics, practice patterns, and important factors considered in 1L/1LM selection. Multivariable logistic regression was used to assess factors associated with more vs less frequent 1L/1LM prescribing. Results Physician reports estimated that 23% of patients with la/mUC had not received any systemic therapy in the previous 6 months; however, 46% received 1L, 32% received second-line, and 22% received subsequent-line systemic treatments. Of patients who were receiving 1L treatment, 72% were estimated to be receiving 1L platinum-based chemotherapy. Around 69% of patients eligible for 1LM received the treatment. Physicians categorized as frequent prescribers reported overall survival (OS), disease control rate (DCR), and rate of grade 3/4 adverse events (AEs) as factors associated with 1L treatment selection (all P < .05). OS, rate of grade 3/4 immune-mediated AEs, and inclusion in institutional guidelines were reported as attributes used in 1LM treatment selection (all P < .05). Multivariable analysis revealed OS, DCR, and rate of grade 3/4 AEs as important factors in oncologists’ 1L treatment selection; academic practice setting and use of Response Evaluation Criteria in Solid Tumors version 1.1 were associated with 1LM use (all P < .05). Conclusion OS and AEs were found to be relevant factors associated with offering 1L and 1LM treatment. Variability exists in physicians’ decision-making in the real-world setting for la/mUC.

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Section: Discussionmentioning

confidence: 99%

Evaluating Oncologists’ Practice Patterns and Decision-Making in Locally Advanced or Metastatic Urothelial Carcinoma: The US Physician PARADIGM Study

Gupta,

Costantino,

Ike

et al. 2023

The Oncologist

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“…Although preoperative radiotherapy, as a single modality, can eradicate disease in a small proportion of patients undergoing cystectomy, it seems to improve local control rather than survival when compared with RC alone (93). However, radiation can synergize with immunotherapy to improve clinical outcomes by causing immunogenic cell death and increasing expression of immune markers (94). Following this hypothesis, several trials, such as RADIANT (durvalumab + radiotherapy) (NCT04543110) and RACE IT (nivolumab + radiotherapy) (NCT03529890) prior to cystectomy in MIBC, are still active.…”

Section: Radiotherapy In Mibcmentioning

confidence: 99%

Neoadjuvant Treatment in Muscle-Invasive Bladder Cancer: From the Beginning to the Latest Developments

et al. 2022

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Urothelial carcinoma of the bladder is one of the most prevalent cancers worldwide, diagnosed as muscle invasive in 25% of cases. Although several studies have demonstrated an overall 5% absolute survival benefit at 5 years with cisplatin-based combination neoadjuvant treatment, administration of chemotherapy prior to radical cystectomy (RC) in muscle-invasive bladder cancer (MIBC) patients is still a matter of debate. This may be due to the perceived modest survival benefit, cisplatin-based chemotherapy ineligibility, or fear of delaying potentially curative surgery in non-responders. However, immunotherapy and novel targeted therapies have shown to prolong survival in advanced disease and are under investigation in the neoadjuvant and adjuvant settings to reduce systemic relapse and improve cure rates. Genomic characterization of MIBC could help select the most effective chemotherapeutic regimen for the individual patient. Large cohort studies on neoadjuvant treatments with immune checkpoint inhibitors (ICIs) and molecular therapies, alone or combined with chemotherapy, are ongoing. In this review, we trace the development of neoadjuvant therapy in MIBC and explore recent advances that may soon change clinical practice.

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“…Currently, there are no studies of neoadjuvant FGFR-targeted agents with immunotherapy combination in muscle-invasive disease. There are some concerns about FGFR-targeted therapy being a proper partner of immunotherapy, as FGFR pathway activation is associated with non-T-cell-inflamed tumors in MIBC [72]. In the perioperative setting, only infigratinib (FGFR1-3-selective tyrosine kinase inhibitor) monotherapy is currently being investigated as neoadjuvant (NCT0422804) and adjuvant (NCT04197986) treatment for locally advanced UC.…”

Section: Combination Of Immunotherapy and Other Emerging Agents Or Radiotherapymentioning

confidence: 99%

Perioperative Systemic Treatment for Muscle-Invasive Bladder Cancer: Current Evidence and Future Perspectives

Kim

2021

IJMS

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Radical cystectomy is the primary treatment for muscle-invasive bladder cancer; however, approximately 50% of patients develop metastatic disease within 2 years of diagnosis, which results in dismal prognosis. Therefore, systemic treatment is important to improve the prognosis of muscle-invasive bladder cancer. Currently, several guidelines recommend cisplatin-based neoadjuvant chemotherapy before radical cystectomy, and adjuvant chemotherapy is recommended in patients who have not received neoadjuvant chemotherapy. Immune checkpoint inhibitors have recently become the standard treatment option for metastatic urothelial carcinoma. Owing to their clinical benefits, several immune checkpoint inhibitors, with or without other agents (including other immunotherapy, cytotoxic chemotherapy, and emerging agents such as antibody drug conjugates), are being extensively investigated in perioperative settings. Several studies for perioperative immunotherapy have shown that immune checkpoint inhibitors have promising efficacy with relatively low toxicity, and have explored the predictive molecular biomarkers. Herein, we review the current evidence and discuss the future perspectives of perioperative systemic treatment for muscle-invasive bladder cancer.

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Systemic treatment for advanced urothelial cancer: an update on recent clinical trials and current treatment options

Cited by 13 publications

References 140 publications

Evaluating Oncologists’ Practice Patterns and Decision-Making in Locally Advanced or Metastatic Urothelial Carcinoma: The US Physician PARADIGM Study

Evaluating Oncologists’ Practice Patterns and Decision-Making in Locally Advanced or Metastatic Urothelial Carcinoma: The US Physician PARADIGM Study

Neoadjuvant Treatment in Muscle-Invasive Bladder Cancer: From the Beginning to the Latest Developments

Perioperative Systemic Treatment for Muscle-Invasive Bladder Cancer: Current Evidence and Future Perspectives

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