Unanswered questions in frontline bladder cancer

Phillip Palmbos, MD, PhD, assistant professor, University of Michigan Health, Assistant Professor, University of Michigan Health, describes 4 key unmet questions in the first-line and neoadjuvant bladder cancer settings.

The first question is whether or not there is a role for combination chemoimmunotherapy in first-line bladder cancer in light of the phase 3 IMvigor130 (NCT02807636) and KEYNOTE-361 (NCT02853305) trials not demonstrating a statistically significant improvement in overall survival with frontline chemoimmunotherapy combinations. The second question is whether or not there is a role for newer antibody-drug conjugates, such as enfortumab vedotin and sacituzumab govitecan, with or without chemotherapy in earlier stages of disease. The third question is, “What’s the role of immunotherapy and other new agents in the neoadjuvant space?” and the fourth question is, “What is the optimal adjuvant therapy for high-risk muscle-invasive bladder cancer patients who did not receive prior chemotherapy in the neoadjuvant space?”