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 final segment of the roundtable series, the panel discusses studies and areas of interest related to treatment options for advanced bladder cancer, in particular the THOR and NORSE studies.
Dr. Koshkin: I think maybe we’ll conclude by asking each of the panelists what are, and we’ve discussed some of these already, but what are the most impactful studies in bladder cancer that you see at this meeting [ASCO 2023]? What do you most look forward to dissecting more?
Dr. Sternberg: I think that we’ve seen a lot of progress. I mean, for 30 years all we had was MVAC [methotrexate, vinblastine, doxorubicin, cisplatin] and gemcitabine/platinum. With the advent of 5 new immunotherapies and 2 antibody drug conjugates and erdafitinib, we have really seen quite important advances. I don’t know that this meeting has so much more different. I think the only really new study we’re going to be seeing is the results of the NORSE study in the platinum-ineligible patients with the combination of erdafitinib and immunotherapy. That’ll be a new study and something different that we haven’t seen yet. I don’t know if it’s going to change practice because, again, only 1 in 10 patients are going to be FGFR2 or FGFR3 positive.
Dr. Petrylak: I would agree. I think that the THOR study and the NORSE studies are both important trials. They really validate the FGFR target for this disease. Certainly, we’re going to see a further presentation of the EV-103 cohort A data, which is very, very similar and confirms what’s been seen previously with this particular combination.
I think that the future is really going to depend upon biology. How do we select these patients? Can we find a marker for enfortumab or sacituzumab? Can we find a marker that will tell us whether we should give immune therapy again or not? It’s going to be more complex to do these trials because we have other drugs in the pipeline at this point. How do we design clinical trials in this particular era of new drug discovery? It’s going to be a challenge.
Dr. Zibelman: Yeah. I mean, I think you guys stole a lot of the good ones. I think the enfortumab vedotin (EV)/pembrolizumab follow up will certainly be the most exciting, and I think the biggest practice-changing, although I think we’re already often going to be doing that now at this point. I think really I’ll highlight that we are ready and now need new targets and new potential drugs. I think we have had the ascension of some of these therapies now and become part of standard of care. I think now really we need to get new areas to go after or new drugs that are promising for some of our patients. Because if you look at ASCO this year, there’s not a lot of that. There are very few results from phase 1s and new promising drugs that are out there at the moment. I look forward to hopefully seeing that increase in the near future.
Dr. Koshkin: Yeah. Like maybe even with the antibody-drug conjugates targeting other things that we discussed.
Dr. Zibelman: Yeah. Or maybe other immuno-type therapies, whether it’s more bispecifics or T-cell-mediated therapies that we’re starting to see come into some other places, and whether there can be a role for those in urothelial carcinoma.
Dr. Sternberg: We’re participating in an NCI [National Cancer Institute] trial, Andrea Apolo, MD, is leading it, with urothelial and non-urothelial for patients with primarily HRR abnormalities, but also other biomarker abnormalities with olaparib to look at if a PARP inhibitor can work also in urothelial cancer. It should be interesting. I don’t know any results yet.
Dr. Koshkin: I want to thank this wonderful panel for your wonderful thoughts on this fascinating topic. Thank you for your attention.