Dr Wang on Switch Maintenance Therapy in Urothelial Carcinoma

Jue Wang, MD, professor, Department of Internal Medicine, member, Division of Hematology and Oncology, UT Southwestern Medical Center, discusses the benefits of switch maintenance therapy and individualized treatment strategies in patients with relapsed or refractory urothelial carcinoma.

The standard of care for patients with relapsed/refractory disease has historically been a one-size-fits-all approach because of the limited armamentarium in urothelial cancer Wang says. However, new strategies, such as switch maintenance therapy, have emerged to help prevent disease relapse and improve outcomes in this population, Wang notes.

In the past, patients with urothelial cancer often received a fixed number of cycles of a given treatment regimen, followed by a break in their treatment, Wang explains. However, with this strategy, many patients eventually experience disease progression, a more rapid pace of disease upon relapse, and increased disease burden, according to Wang. Furthermore, frailty and organ dysfunction resulting from disease progression can make these patients ineligible for second or third lines of therapy, Wang emphasizes.

Switch maintenance therapy involves switching a patient from receiving frontline chemotherapy to receiving maintenance immunotherapy before disease progression, rather than giving them a treatment break, Wang says. This treatment strategy is supported by research showing the complementary relationship between chemotherapy and immunotherapy, Wang explains. Although chemotherapy was once considered immunosuppressive, it is now understood that immunotherapy can enhance patients’ immune systems by immunogenically killing cancer cells and releasing neoantigens, Wang notes. Switch maintenance therapy has demonstrated superior survival improvements compared with traditional urothelial cancer treatment approaches, Wang emphasizes.

In the past, patients who were refractory to 1 chemotherapy agent received a different chemotherapy agent, according to Wang. However, this treatment strategy is ineffective because chemotherapy puts therapeutic pressure on highly mutated cancer cells, Wang says. Since patient characteristics vary, a one-size-fits-all approach does not work for all patients, Wang adds.

Now, patients with chemotherapy-refractory disease have individualized treatment options. These includeing monoclonal antibodies, which deliver chemotherapy directly to the cancer cells, and immunotherapy, which targets cancer-related immunosuppression, Wang explains. In addition, targeting the molecular vulnerability of the cancer is effective in certain patient subgroups, and traditional chemotherapy is still an option, Wang concludes.