Bladder Cancer

Until 5 years ago, systemic therapeutic options for urothelial carcinoma, the most common form of bladder cancer, had been limited to cisplatin-based regimens and taxanes. This article explores the current and future outlooks for combination therapy with IOs in urothelial carcinoma.

CancerNetwork® sat down with Matthew D. Galsky, MD, at the 2021 ASCO Annual Meeting to discuss his thoughts on research he believes has the greatest potential to impact standard of care treatment of bladder cancer.

As a bladder-sparing treatment strategy, transurethral resection of the bladder tumor with nivolumab and chemotherapy showed promise for patients with muscle-invasive bladder cancer.

CancerNetwork® sat down with Matthew D. Galsky, MD, at the 2021 ASCO Annual Meeting to talk about data from a phase 2 trial examining the use of neoadjuvant nivolumab plus gemcitabine/cisplatin prior to bladder-sparing surgery.

Regardless of primary tumor site or disease stage, avelumab maintenance was able to elicit overall survival benefit versus best supportive care for platinum-treated urothelial cancer.

Vikram Narayan, MD, details the little-known fact that tobacco cessation is a leading preventative strategy of bladder cancer recurrence.

Vikram Narayan, MD, expanded on his data regarding nadofaragene and NMIBC published at this year’s SUO Meeting.

Narayan expanded on the other studies he contributed to from SUO investigating nadofaragene for patients with NMIBC.

At the 2020 SUO Meeting, Vikram M. Narayan, MD, spoke about the preliminary finds of his work with nadofaragene firadenovec.

Narayan discusses what he thinks the future of nadofaragene firadenovec and bladder cancer are at this year’s SUO Meeting.

Patients who underwent pouch diversion reported significantly more regret than patients undergoing neobladder or ileal conduit.

Data for a key study secondary outcome measure showed that 56.1% of patients who achieved a complete response to Jelmyto maintained that response at 12 months.

“Providers should consider using BLC for surveillance of high-risk NMIBC patients undergoing BCG as it could change clinical management by identifying patients who are BCG unresponsive and eligible for alternative therapy and clinical trials,” said Meera Chappidi, MD.

The efficacy of the novel intravesical gene-mediated therapy nadofaragene firadenovec was sustained across subgroups of patients with high-grade, BCG-unresponsive non-muscle invasive bladder cancer.

This study found that radiation therapy may provide some benefit for patients with high-risk non–muscle invasive bladder cancer, though the quality of evidence in this current setting is low.

Research suggested oncologists may recommend specific timeframes in which cystectomy should be performed to avoid unnecessary mortality due to delays.

Researchers sought to better understand the impact of treatment on intimate relationships for patients with bladder cancer.

A recent study published in Science evaluated DNA changes in healthy and disease-laden bladder tissue, finding that cancer-driving mutations are common in healthy bladder tissue.

Combination treatment with tremelimumab and durvalumab was found to be well-tolerated and showed early signs of activity in certain patients with localized bladder cancer who are not eligible for cisplatin-based chemotherapy.

“This is the first trial to report objective responses in patients with advanced urothelial cancer who had previously received immunotherapy but were ineligible for cisplatin in this setting due to inadequate kidney function or other conditions,” Roger Dansey, MD, said in a press release.

This study suggested that the customized bioinformatics workflow, UroCAD, be used as a noninvasive approach for diagnosis and recurrence surveillance in patients with urothelial carcinoma prior to the use of cystoscopy.

According to researchers, these findings suggest “that as long as a person is not smoking at the time of chemotherapy and surgery, they might do better.”

Researchers suggested these results from CheckMate-274 “point to the potential for nivolumab to become a new standard of care in the adjuvant setting, extending disease-free survival for post-surgery patients with muscle-invasive urothelial cancer without the use of chemotherapy.”

Patients with locally advanced or metastatic urothelial carcinoma receiving enfortumab vedotin had increased overall survival at 12- and 18-month intervals.

Sacituzumab govitecan-hziy induced significant activity with favorable tolerability in heavily pretreated patients with metastatic urothelial carcinoma.

Durvalumab, with or without tremelimumab, failed to meet its primary end point of overall survival in patients with metastatic urothelial cancer.

Induction avelumab prior to standard of care led to a clinically relevant worsening of survival as the first-line treatment for patients with metastatic urothelial carcinoma.

The clinical trial is comparing enfortumab vedotin-ejfv to chemotherapy in adult patients with locally advanced or metastatic urothelial cancer who were previously treated with a platinum-based chemotherapy and a PD-1 or PD-L1 inhibitor.

In this study, patients with advanced urothelial carcinoma saw worse outcomes with proton pump inhibitor (PPI) use when treated with atezolizumab, compared with those who were not treated with PPIs.

In this study, antibiotic use was consistently associated with worse survival outcomes in patients with urothelial carcinoma treated with atezolizumab, but not chemotherapy.