Practice Changing Results from Clinical Trials in Metastatic Urothelial Cancer
Urothelial carcinoma (UC) is the most common cancer of the urinary tract and the sixth most frequently diagnosed cancer in the United States.[SEER] Historically, patients with unresectable locally advanced or metastatic urothelial UC (mUC) have had a poor prognosis, particularly if they are platinum-ineligible or if their cancer progresses after platinum-based chemotherapy. However, new treatments and therapeutic combinations are becoming available in first and later-line settings and offer promise for improved clinical outcomes. In this update, I highlight recent results from clinical trials, noting which findings are practice changing and which are worthy of further investigation.
Bladder cancer is common and challenging to treat. A thorough assessment of the molecular biology and immunology background has pinpointed potential biomarkers, “drivers” and promising therapeutic targets. The advent of immune checkpoint inhibitors (ICI) has heralded a new era after approximately two decades of a “stagnant landscape”. As single agents in patients with advanced urothelial carcinoma, ICI can induce rapid and durable responses, with a very small proportion of patients achieving long term remission. However, most patients do not achieve response, while a proportion may have immune-related adverse events. Therefore, there is an urgent need for additional therapies that raise the bar, improve quality of life, and prolong the life of our patients.