Events

Videos

Podcasts

Articles

Sylvester Annual Oncology Updates

Marijo Bilusic, MD, PhD, medical oncologist, Genitourinary Medical Oncology, University of Miami Health System, Sylvester Comprehensive Cancer Center, discusses key trials in the treatment armamentarium for patients with urothelial carcinoma, as presented at the 2023 Sylvester Annual Oncology Updates Meeting.

Bilusic presented on the topic of the phase 1/2 EV-103/KEYNOTE-869 study (NCT03288545),which evaluated enfortumab vedotin-ejfv (Padcev) plus pembrolizumab (Keytruda) in cisplatin-ineligable patients with locally advanced or metastatic urothelial carcinoma. Based on the findings from this study, in April 2023, 

this treatment for use in the frontline setting in this patient population

. Notably, this approval marks a significant shift in how oncologists approach the treatment of patients with metastatic urothelial cancer, particularly in the frontline setting, Bilusic emphasizes. 

Another topic addressed at the meeting was the SWOG S1011 study (NCT01224665), which delved into surgical considerations, evaluating standard or extended pelvic lymphadenectomyin the treatment of patients undergoing surgery for invasive bladder cancer. This topic is significant for patients, who often inquire about the necessity of lymph node removal, Bilusic emphasizes. One crucial takeaway from this trial, findings from which were presented in 2023, is that extensive lymphadenectomies are not imperative, he states. Adhering to the standard node removal procedure yields survival outcomes equivalent to those achieved with extensive pelvic lymphadenectomies and is less morbid, Bilusic explains. This study offers valuable insights into optimizing surgical procedures for patients who have undergone chemotherapy, he notes.

Bilusic continues that the final aspect of the discussion centered on the treatment sequence for managing urothelial carcinoma. Although enfortumab vedotin plus pembrolizumab is not yet FDA approved for cisplatin-eligible patients, data to support the use of this combination in this population may be presented at upcoming medical meetings, he explains. Bilusic anticipates that this potential approval will reconfigure treatment approaches in urothelial cancer and may position the combination as the most frequently prescribed frontline therapy for patients with urothelial cancer, he concludes.

Marijo Bilusic, MD, PhD, discusses key trials in the treatment armamentarium for patients with urothelial carcinoma, as presented at the 2023 Sylvester Annual Oncology Updates Meeting. 


Dr Bilusic on Key Trials That Inform the Treatment of Patients With Urothelial Carcinoma

Marijo Bilusic, MD, PhD, medical oncologist, Genitourinary Medical Oncology, University of Miami Health System, Sylvester Comprehensive Cancer Center, discusses updates seen in the treatment armamentarium for patients with urothelial carcinoma, as presented at the 2023 Sylvester Annual Oncology Updates Meeting.

Numerous topics were covered during the event, which primarily focused on the phase 3 VESPER trial (NCT01812369), Bilusic begins. This trial involved a comparison between 2 chemotherapy regimens, 6 cycles of high-dose MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) vs 4 cycles of gemcitabine/cisplatin, in patients with locally advanced bladder cancer, he says. The initial findings from this trial, which were published in 2020, yielded a positive outcome with high-dose MVAC. However, the significant development with this trial in 2023 was the report of the 5-year overall survival (OS) data, which revealed an improvement in OS rates with MVAC vs gemcitabine plus cisplatin, Bilusic explains. These findings demonstrated the importance of delivering more cisplatin-based chemotherapy, as opposed to less, in patients with locally advanced bladder cancer, he notes. 

Both regimens used in VEPSER are cisplatin-based, Bilusic expands. It is important to recognize that the VESPER data likely indicate the benefit of higher cisplatin doses, rather than a benefit of MVAC over gemcitabine plus cisplatin, he adds. Notably, approximately 80% of patients in the MVAC arm could not complete all 6 cycles of treatment because of treatment-related toxicity, a vital point to consider when discussing chemotherapy options with patients, he emphasizes. Prior to this trial, the treatment recommendation for patients with locally advanced urothelial carcinoma was 3 to 4 cycles of chemotherapy. However, the VESPER data indicate that a more extended treatment duration is advisable, Bilusic explains. This shift in recommendation is a central message that was conveyed during the Sylvester Annual Oncology Updates Meeting.

A notable number of patients who received 6 cycles of chemotherapy died within the 5-year survival timeframe, a result that fell short of desired outcomes, Bilusic continues. The findings from VESPER and other trials emphasize the need for a critical reevaluation of bladder cancer treatment strategies, specifically concerning the delivery of cisplatin-based chemotherapy, Bilusic adds. The lessons learned from bladder cancer research will guide discussions with patients and inform decision-making processes as clinicians continue to aim for improved survival rates and better patient outcomes, Bilusic concludes.

Marijo Bilusic, MD, PhD, discusses updates seen in the treatment armamentarium for patients with urothelial carcinoma, as presented at the 2023 Sylvester Annual Oncology Updates Meeting.


Sylvester Annual Oncology Updates | Conference

Dr Bilusic on Key Trials That Inform the Treatment of Patients With Urothelial Carcinoma

Dr Bilusic on Updates to the Urothelial Carcinoma Treatment Armamentarium