Optimizing management of advanced urothelial carcinoma: A review of emerging therapies and biomarker-driven patient selection

Authors

  • Peter C. Black
  • Nimira S. Alimohamed Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
  • David Berman Kingston Health Sciences Centre, Queen’s University, Kingston, ON
  • Normand Blais Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC, Canada
  • Bernhard Eigl BC Cancer, Vancouver, BC, Canada
  • Pierre I. Karakiewicz Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
  • Wassim Kassouf McGill University Health Centre, McGill University, Montreal, QC, Canada
  • Girish S. Kulkarni Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada.
  • Michael Ong Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
  • Alan Spatz Jewish General Hospital, McGill University, Montreal, QC, Canada
  • Srikala S. Sridhar Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
  • Tracy Stockley University Health Network, University of Toronto, Toronto, ON, Canada
  • Theodorus van der Kwast Department of Pathology and Laboratory Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
  • Huong Hew Medical Affairs, Janssen Inc, Toronto, ON, Canada
  • Laura Park-Wyllie Medical Affairs, Janssen Inc, Toronto, ON, Canada
  • Scott A. North Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada

DOI:

https://doi.org/10.5489/cuaj.6458

Keywords:

bladder cancer, metastasis, immunotherapy, FGFR targeted therapy, chemotherapy

Abstract

Introduction: Advanced urothelial carcinoma has been challenging to treat due to limited treatment options, poor response rates, and poor long-term survival. New treatment options hold the promise of improved outcomes for these patients.

Methods: A multidisciplinary working group drafted a management algorithm for advanced urothelial carcinoma using “consensus development conference” methodology. A targeted literature search identified new and emerging treatments for inclusion in the management algorithm. Published clinical data were considered during the algorithm development process, as well as the risks and benefits of the treatment options. Biomarkers to guide patient selection in clinical trials for new treatments were incorporated into the algorithm.

Results: The advanced urothelial carcinoma management algorithm includes newly approved first-line anti-programmed death receptor-1 (PD1)/ programmed death-ligand 1 (PD-L1) therapies, a newly approved anti-fibroblast growth factor receptors (FGFR) therapy, and an emerging anti-Nectin 4 therapy, which have had encouraging results in phase 2 trials for second-line and third-line therapy, respectively. This algorithm also incorporates suggestions for biomarker testing of PD-L1 expression and FGFR gene alterations.

Conclusions: Newly approved and emerging therapies are starting to cover an unmet need for more treatment options, better response rates, and improved overall survival in advanced urothelial carcinoma. The management algorithm provides guidance on how to incorporate these new options, and their associated biomarkers, into clinical practice.

Downloads

Download data is not yet available.

Published

2020-03-23

How to Cite

Black, P. C., Alimohamed, N. S., Berman, D., Blais, N. ., Eigl, B., Karakiewicz, P. I. ., Kassouf, W., Kulkarni, G. S., Ong, M., Spatz, A., Sridhar, S. S., Stockley, T., van der Kwast, T., Hew, H. ., Park-Wyllie, L., & North, S. A. (2020). Optimizing management of advanced urothelial carcinoma: A review of emerging therapies and biomarker-driven patient selection. Canadian Urological Association Journal, 14(8), E273–82. https://doi.org/10.5489/cuaj.6458