Dr. Galsky on Sequencing Questions in Urothelial Cancer

Matthew Galsky, MD, a professor of medicine; director of Genitourinary Medical Oncology; director of the Novel Therapeutics Unit; and co-director of the Center of Excellence for Bladder Cancer at the Tisch Cancer Institute and the Icahn School of Medicine at Mount Sinai, discusses sequencing questions in urothelial cancer.

Traditionally, when it came to the treatment of patients with urothelial cancer, sequencing rarely had to be questioned since very few agents were available, says Galsky. However, now more options are available and these agents appear to be non–cross-resistant because they demonstrate activity when used sequentially, says Galsky. Although this is exciting news, it raises several questions, Galsky adds.

Investigators must now determine which agent should be used first and whether the drugs should be used in combination, Galsky explains. The rationale for combination therapy is based on potential synergy and the concept of non-cross resistance. Additionally, data in model systems demonstrate that certain sequences could result in better outcomes for patients, Galsky adds.

However, these questions can only be answered in the context of randomized clinical trials, Galsky says. Although some insight is available regarding sequencing in this space, investigators will need to conduct several studies before they are able to identify the sequences that will truly optimize patient care, Galsky concludes.