Dr. Petrylak on Available Treatment Options in Metastatic Bladder Cancer

Daniel P. Petrylak, MD, professor of medicine and urology, co-leader, Cancer Signaling Networks, Yale Cancer Center, and 2017 Giant of Cancer Care^® in Genitourinary Cancers, discusses available treatment options in metastatic bladder cancer.

Regarding immunotherapy, atezolizumab (Tecentriq) and pembrolizumab (Keytruda) are currently approved by the FDA for the frontline treatment of patients with locally advanced or metastatic urothelial carcinoma who are ineligible for cisplatin-containing chemotherapy and whose tumors express PD-L1.

In January 2020, pembrolizumab was approved for patients with Bacillus Calmette-Guerin (BCG)—unresponsive, high-risk, non-muscle invasive bladder cancer with carcinoma in situ with or without papillary tumors who are ineligible for or have elected not to undergo cystectomy.

The checkpoint inhibitors pembrolizumab, atezolizumab, durvalumab (Imfinzi), nivolumab (Opdivo), and avelumab (Bavencio) are approved in the second-line setting for patients who progress on or following cisplatin-based chemotherapy, says Petrylak.

In April 2019, erdafitinib (Balversa) was granted an accelerated approval for the treatment of patients with locally advanced or metastatic bladder cancer with an FGFR3 or FGFR2 alteration that have progressed on platinum-containing chemotherapy. Patients with these mutations account for about 10% to 20% of all patients with metastatic bladder cancer, says Petrylak.

Finally, the Nectin-4—directed antibody-drug conjugate enfortumab vedotin-ejfv (Padcev) was granted an accelerated approval in December 2019 for the treatment of adult patients with locally advanced or metastatic urothelial cancer who have previously received a PD-1/PD-L1 inhibitor and platinum-containing chemotherapy in the neoadjuvant/adjuvant, locally advanced or metastatic setting.

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