ASCO GU 2018: Erdafitinib, a Pan-fibroblast Growth Factor Receptor Inhibitor, in Patients with Metastatic or Unresectable Urothelial Carcinoma and FGFR Alterations

San Francisco, CA (UroToday.com) Although immune checkpoint inhibitors (ICI) have improved outcomes in some patients with platinum-resistant metastatic or unresectable urothelial carcinoma (mUC), many patients (eg, patients with TCGA luminal 1 tumors, many of whom are FGFR alterations (FGFRa)) may not benefit. Erdafitinib (ERDA; JNJ-42756493), a pan-fibroblast growth factor receptor (pan-FGFR) (1-4) inhibitor, demonstrated promising phase 1 activity: 11 partial responses among 24 FGFRa mUC pts. We report efficacy and safety of ERDA in the ongoing global open-label phase 2 study BLC2001 (NCT02365597).

ASCO GU 2018: Docetaxel with or without Ramucirumab After Immune Checkpoint Inhibition in Platinum-refractory Metastatic Urothelial Carcinoma (Muc): Prespecified Subgroup Analysis from the Phase 3 Range Trial

San Francisco, CA (UroToday.com) Immune checkpoint inhibitors are revolutionizing the management of advanced and metastatic urothelial cancer. There are a growing number of approved immune checkpoint inhibitors (ICI’s) in this disease space, specifically after failing platinum-based chemotherapy, and as with ICI treatment in all cancers, the objective response rate (ORR) is between 15-20%.

ASCO GU 2018: Size-focality-invasion in Upper Tract Urothelial Carcinoma - A Novel Imaging-Based Score To Predict Survival Outcomes

San Francisco, CA (UroToday.com) Upper tract urothelial cell carcinoma (UTUC) is an uncommon aggressive malignancy with disparate outcomes. The authors developed a novel morphometric scoring system for prediction of oncologic and survival outcomes before nephroureterectomy (NU).

ASCO GU 2018: Effectiveness of Transurethral Resection Plus Systemic Chemotherapy as Definitive Treatment for Muscle-Invasive Bladder Cancer

San Francisco, CA (UroToday.com) Transurethral resection of bladder tumor (TURBT) + neoadjuvant cisplatin-based chemotherapy achieves a pathologic complete response in 30-40% of patients with muscle invasive bladder cancer (MIBC). Prior studies have demonstrated that long-term survival is possible for a subset of patients with MIBC treated with TURBT plus chemotherapy alone, but such analyses have been limited by small sample sizes and poor generalizability. In this study, the authors aimed to describe the characteristics and outcomes of patients managed with this approach using a large national registry.

ASCO GU 2018: Impact of Number of Cycles of Platinum-based First-line Chemotherapy for Advanced Urothelial Carcinoma

San Francisco, CA (UroToday.com) Neoadjuvant chemotherapy (NAC) prior to radical cystectomy for localized muscle-invasive bladder cancer (MIBC) and systemic chemotherapy for the treatment of locally advanced or metastatic bladder cancer are based on the use of platinum-based chemotherapy, specifically cisplatin. As the authors note, 6 cycles of platinum-based chemotherapy (CT) are conventionally utilized in this setting, but this chemotherapy is not without its associated toxicity, particularly cumulative toxicities. This can make it challenging to deliver the full 6 cycles of cisplatin-based chemotherapy. However, there is no prospective data on the number of cycles required for appropriate response.

In this large multi-institutional, international collaborative, the authors retrospectively address this issue. They utilized the Retrospective International Study of Invasive/Advanced Cancer of the Urothelium (RISC) database. They examined the association of the number of cycles of platinum-based first-line CT with overall survival (OS) after controlling for previously recognized prognostic factors used in a nomogram.

ASCO GU 2018: Clinical Outcomes of Patients with Histologic Variants of Urothelial Carcinoma Treated with Tetra-Modality Bladder-Sparing Protocol Incorporating Consolidative Partial Cystectomy

San Francisco, CA (UroToday.com) Tri-modal therapy (TMT) enabling bladder-sparing has become an accepted treatment for selected patients with muscle-invasive bladder cancer (MIBC). As some of the histologic variants of urothelial carcinoma (VUC) are more resistant to chemotherapy and radiotherapy compared with pure urothelial carcinoma (PUC), it is still unclear whether bladder-sparing therapy provides comparable disease control in VUC. The authors report on development of a tetra-modality bladder-sparing therapy, consisting of maximal transurethral resection (TUR), chemoradiotherapy (CRT), and consolidative partial cystectomy, which has theoretical advantage in locoregional control by surgically eliminating chemo- and radio-resistant cells.

ASCO GU 2018: Comparative Effectiveness of Bladder-preserving Tri-modality Therapy Versus Radical Cystectomy for Muscle-invasive Bladder Cancer

San Francisco, CA (UroToday.com) Muscle-invasive bladder cancer (MIBC) drives the mortality of bladder cancer as a disease, and until now, the only level 1 evidence for its management supports the use of neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC). However, NAC + RC is a highly morbid intervention, particularly in the elderly population that entails the bladder cancer patient pool.