Oncology News Central (ONC)Major Bladder Cancer Study Disappoints: “We Won’t Have a Whole Lot of Other Treatment Options”

Bladder Cancer Treatment Options Narrow Following TROPiCs-04 Trial Results, Prompting Need for New Approaches

Recent advancements in urothelial carcinoma treatments have sparked excitement within the oncology community. However, the TROPiCs-04 trial results have dampened this enthusiasm by revealing limited efficacy for sacituzumab govitecan in post-platinum and immune checkpoint therapy settings. In this video from ASCO 2024 with Ulka Vaishampayan, MD, director of the Phase I Program at the Rogel Cancer Center and professor of internal medicine at the University of Michigan in Ann Arbor, she highlights the ongoing challenges in treating bladder cancer, particularly after disease relapse, and stresses the need for new therapeutic strategies and clinical trials.

Key Points:

• Frontline Therapy Shift: Enfortumab vedotin and pembrolizumab have become the standard of care for metastatic urothelial carcinoma, shifting away from cisplatin eligibility.
• TROPiCs-04 Trial Outcome: Sacituzumab govitecan did not demonstrate superior overall survival compared to physician’s choice of taxane-based chemotherapy in a phase 3 randomized trial.
• Post-Relapse Treatment Dilemma: The failure of sacituzumab govitecan in the TROPiCs-04 trial leaves a gap in post-relapse treatment options, necessitating a reconsideration of platinum-based chemotherapy.
• Evidence-Free Zone: The progression of patients after frontline enfortumab and pembrolizumab therapy creates an “evidence-free zone” regarding subsequent treatment choices.
• Next-Generation Sequencing: Identifying FGFR2 and FGFR3 mutations through next-generation sequencing is crucial for selecting patients for FGFR inhibitors like erdafitinib.
• Ongoing Clinical Trials: Trials investigating VEGF-tyrosine kinase inhibitors and other targeted agents are essential to expand therapeutic options for bladder cancer.
• Quality of Life Considerations: The EV-302 quality-of-life data emphasizes the importance of balancing treatment efficacy with the impact on patients’ quality of life, particularly for those on prolonged enfortumab therapy.
• Subgroup Analyses: Studies such as CheckMate901 provide insights into patient subsets, like lymph node-only disease patients, helping refine treatment strategies.

“If the patients are benefiting and continuing to maintain clinical benefit and tolerability of the medication, I would absolutely keep going.”
– Dr. Ulka Vaishampayan

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