Dr. Rosenberg Discusses Challenges in Metastatic Urothelial Carcinoma

Jonathan E. Rosenberg, MD, medical oncologist, chief, Genitourinary Medical Oncology Service, Memorial Sloan Kettering Cancer Center, discusses challenges in the treatment of patients with metastatic urothelial carcinoma.

Rosenberg says that one of the remaining unmet needs in metastatic urothelial carcinoma is the first-line treatment of patients with low levels of PD-L1 expression. Findings from the CheckMate-032 study of nivolumab (Opdivo) and ipilimumab (Yervoy) showed a significantly higher response rate in the PD-L1 ≥50% cohort compared with the PD-L1—low cohort. However, the PD-L1–low cohort did just as well as every other patient who received a checkpoint inhibitor, Rosenberg notes. Combination therapy may help these patients, he adds, but that has not been established.

Mechanisms of resistance—either intrinsic or acquired—remain one of the biggest questions in urothelial carcinoma, according to Rosenberg. Over the next few years, he hopes to see this question addressed as biomarkers from trials of checkpoint inhibitors are analyzed.

Additionally, FGFR3 inhibitors and antibody-drug conjugates may be beneficial when used in combination with immunotherapy, Rosenberg says, as they have shown activity in patients with platinum- and immunotherapy-refractory tumors.