He first offered a timeline of the evolution of systemic treatment options in advanced urothelial carcinomas.
In his discussion of Abstract 698O, Dr. Gschwend summarized the data as indicating the addition of immunotherapy with atezolizumab to platinum-based chemotherapy did not negatively impact patient-reported outcomes. He noted that this is an important analysis in the weighing of overall benefit of adding immunotherapy to chemotherapy, especially if the overall survival data eventually show a benefit to combination therapy as well. The findings in 698O are consistent with other data from JAVELIN Bladder 100 showing no compromise in patient-reported outcomes with avelumab maintenance therapy after first-line chemotherapy.
In his discussion of Abstract 699O, Dr. Gschwend noted that the more complex markers beyond tumor mutational burden and PD-L1 status are promising hypotheses for prospective evaluation, but not yet ready for clinical application. He also noted that tissue remains the issue, as differences in profiling of primary and metastatic tissue, as well as spatial heterogeneity within the tumor are likely to impact the applicability of molecular biomarkers.
Finally, in his discussion of Abstract LBA24, Dr. Gschwend made comparisons between the efficacy of sacituzumab with the other antibody-drug conjugate drug in advanced development for heavily pre-treated metastatic urothelial cancer, enfortumab vedotin. These drugs have both been tested in heavily pre-treated patients that have visceral and liver metastases. As shown below, they have comparable single agent activity, but phase 3 randomized clinical data is still required to fully assess their impact.
He concluded by offering a potential schematic for first line treatment options in metastatic urothelial carcinoma, which is shown below. The benefit of adding upfront immune checkpoint blockade to chemotherapy in the first line setting remains unclear in the context of pending survival data in IMvigor130 and negative KEYNOTE-361 and DANUBE trials presented at this conference.
Presented by: Juergen Gschwend, MD, Professor and Chairman of the Department of Urology, rechts der Isar Medical Center, Technical University, Munich, Munich, Germany
Written by: Alok Tewari, MD, PhD, Medical Oncologist at the Dana-Farber Cancer Institute, at the European Society for Medical Oncology Virtual Congress, ESMO Virtual Congress 2020 #ESMO20, 18 Sept - 21 Sept 2020.