A medical oncologist specializing in urothelial carcinoma reviews key data on erdafitinib, enfortumab vedotin, and sacituzumab govitecan.
Case 1: A 72-Year-Old Man with Metastatic Urothelial Carcinoma
Initial Clinical Presentation:
Initial Clinical Workup:
Initial Treatment and Disease Progression:
This is a synopsis of a Case-Based Peer Perspectives series featuring Scott T. Tagawa, MD, MS, FACP, FASCO, of Weill Cornell Medicine.
Scott T. Tagawa, MD, MS, FACP, FASCO discussed new data supporting use of targeted therapies after progression on first-line platinum chemotherapy and immune checkpoint inhibition in advanced urothelial carcinoma.
He first mentioned erdafitinib, a pan-FGFR inhibitor. Data presented at ASCO 2023 showed improved outcomes with erdafitinib versus chemotherapy in patients with FGFR3 mutations or FGFR2/3 fusions. As FGFR alterations are found in 15-20% of urothelial carcinomas, Dr. Tagawa emphasized checking for these biomarkers in all patients.
He then discussed results of the phase 3 EV-301 trial leading to FDA approval of enfortumab vedotin, an antibody-drug conjugate targeting Nectin-4, for locally advanced or metastatic urothelial carcinoma after platinum chemotherapy and checkpoint inhibition. Enfortumab vedotin improved overall survival, progression-free survival, and response rate versus chemotherapy. However, there are unique adverse events, including ocular toxicity and fatal hyperglycemia, requiring monitoring and dose modifications.
Dr. Tagawa next reviewed data on sacituzumab govitecan, an antibody-drug conjugate linking SN-38 (active metabolite of irinotecan) to an anti-Trop-2 antibody. Results from the phase 2 TROPHY-U-01 trial in ≥3rd line metastatic urothelial carcinoma showed an overall response rate of 27-29%. This led to accelerated FDA approval given response rate improvements over historical chemotherapy.
In conclusion, Dr. Tagawa summarized emerging data supporting new targeted therapies in specific molecularly-defined subsets of metastatic urothelial carcinoma. Biomarker analysis at diagnosis is key to identify patients who may benefit. Research continues with additional targeted agents and immunotherapies aiming to improve outcomes in advanced disease.
*Video synopsis is AI-generated and reviewed by Urology Times editorial staff.