Can Targeted Therapies Move the Field Toward More Individualized Bladder Cancer Treatment?

A roundtable discussion, moderated by Vadim Koshkin, MD, of the University of California, San Francisco, focused on treatment selection for different patient populations with advanced bladder cancer, including a discussion of new data presented at ASCO 2023. Dr. Koshkin was joined by a panel that included Matthew Zibelman, MD; Cora Sternberg, MD; and Daniel Petrylak, MD.

In the next segment of the roundtable series, the panel discusses the potential for more targeted treatments making their way into the advanced bladder cancer space.

Watch the next segment in this roundtable series.

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Dr. Koshkin: As you mentioned, bladder cancer is certainly not where lung cancer is in terms of being able to target different drivers. We have at least 1 now, the positive phase 3 trial of erdafitinib. Do you see us as moving in that direction where we may be able to individualize treatment more? Also with, I should say, availability of maybe now other drugs maybe targeting HER2, for instance?

Dr. Zibelman: That’s where I was going to go with that. I think that is certainly the next group that I think there’s excitement for. We appear to have good antibody-drug conjugates targeting HER2 where we’ve had failures with prior HER2-targeted drugs in the past. I do think we’re better with designing the antibody-drug conjugates and understanding how they work, which is important. I do think we’re seeing that HER2 does seem to be a viable target, and I do think we’ll have another group of patients. I think how to separate these HER2-targeted antibody-drug conjugates with enfortumab vedotin and some of the others is going to be an interesting challenge going forward. But I think we’re getting there. Slowly, but we’re getting there.

Dr. Sternberg: Look at drugs like in HER2 that work even in patients with breast cancer that are only 1 positive. I think those are the kind of drugs we need to be studying in urothelial cancer.

Dr. Koshkin: There’s even now some data in urothelial for HER2-targeting antibody-drug conjugates for low HER2 expressors.

Dr. Petrylak: It’s interesting when Maha Hussain, MBChB, published data a number of years ago with carboplatin/gemcitabine and paclitaxel along with [trastuzumab], when you look at that study, it was disappointing because the median survival was only 15 months. But HER2 marks for a poor prognosis group of patients in that particular trial. These were patients predominantly with visceral metastases, so you wonder whether that was diluted out in the beginning by the patient population that was selected.

Dr. Sternberg: Selected by immunohistochemistry (IHC) also.

Dr. Petrylak: Right. It was IHC. It was also by serum. It was a lot of different. It was any method of positivity was what was used. Certainly, I think that that’s interesting.