Dr. Iyer on Challenges With Selecting Patients With Bladder Cancer for FGFR Inhibitors

Gopa Iyer, MD, medical oncologist at Memorial Sloan Kettering Cancer Center, discusses the challenges faced with identifying an optimal screening methodology to select patients with bladder cancer for FGFR inhibitor therapy.

One of the big issues in bladder cancer has to do with finding the right biomarkers. The question is whether these markers will be a fusion, a mutation, overexpression on an RNA level, or amplification of the gene, says Iyer; the answer remains unknown.

To date, the only FDA approval in this space is for erdafitinib (Balversa), and the use of this agent is based upon screening for FGFR3 mutations over FGFR2/3 fusions, says Iyer. Now that an FDA option is available, conducting testing or sequencing in the metastatic setting is covered by insurance. Many patients with metastatic disease should be tested to see if they meet those criteria of eligibility for erdafitinib therapy, adds Iyer.

In the muscle-invasive setting, it is a bit more challenging, says Iyer. Certainly, sequencing of muscle-invasive specimens can be performed but the main issue will be obtaining insurance coverage because no FDA approval for muscle-invasive FGFR3-mutant bladder cancer exists yet, concludes Iyer.