Novel trends in the systemic treatment of advanced urothelial cancers
DOI: 10.22591/magyurol.2024.1.maraza.42
Authors:
Maráz Anikó dr., Rozsvai Tímea dr.
Szegedi Tudományegyetem, Onkoterápiás Klinika, Szeged (igazgató: Oláh Judit dr.)
Summary
Systemic treatment of urothelial cancers has shown dynamic development in recent years. The standard therapy for bladder cancers in stage T2-T4a N0 M0, in cases suitable for cisplatin, is radical cystectomy (RC) after neoadjuvant (NA) cisplatin (CDDP)-based chemotherapy (ChT). If NA ChT is not performed, in pT3-4 and/or N+ stage, ChT with adjuvant CDDP can be recommended with lower effectiveness. A 1-year adjuvant nivolumab therapy may be considered in PD-L1 positive patients with a high recurrence risk, in case of CDDP ineligibility or after NA ChT. CDDP-based ChT is the first-line treatment for locally advanced or metastatic patients suitable for CDDP, but in a recent study, combining nivolumab with ChT further improved the outcome. The first-line treatment of advanced patients unfit for CDDP but suitable for ChT is carboplatin (CBP)-based ChT, but based on new results, the combination of enfortumab vedotin (EV) and pembrolizumab showed excellent results in any platinum-eligible patient group. In cases responding to 4-6 cycles of platinum-based ChT, maintenance avelumab immunotherapy improves patient survival. In patients progressing
during or after platinum-based ChT, classical ChT is modestly effective in second/multiple lines, immunotherapy should be chosen. In many cases, modern antibody-drug conjugates such as EV and sacituzumab govitecan, as well as erdafitinib in case of FGFR alteration, expand the therapeutic possibilities, improving the life expectencies of patients.