Highlights on urothelial cancer

Dr Jérémy Blanc,  medical oncologist in training from the Institut Jules Bordet, Brussels selected highlights on bladder cancer from ASCO24.

Dr Jae-Lyun Lee presented the first results from the Ultma trial, a phase 2 clinical investigation exploring the efficacy of the modified FOLFIRINOX regimen among individuals afflicted with advanced urachal cancer. Urachal carcinoma, an exceedingly rare malignancy, accounts for less than 1% of all bladder cancers. Twenty-one subjects diagnosed with advanced urachal cancer were recruited for the trial, wherein it was observed that up to 62% of participants exhibited an objective response to the treatment regimen. Moreover, no novel safety concerns were identified with this regimen.

Enfortumab vedotin (EV) has received approval for use both in combination with pembrolizumab and as a standalone therapy for locally advanced or metastatic urothelial cancer. Patient-reported outcomes from the EV-302 trial indicated that patients treated with EV in combination with pembrolizumab experienced no adverse effects on their quality of life, pain levels or functional capabilities.

EV is associated with considerable toxicity, necessitating dose modifications such as reductions and interruptions to manage EV-related adverse events. The relationship between EV plasma exposure, which is influenced by dose adjustments, and the safety and efficacy outcomes was assessed in a post hoc exploratory analysis from 3 EV monotherapy studies. The findings of the study indicate that even when reducing the dose, the efficacy of EV remains preserved compared to chemotherapy.