Dr Sharma on the Impact of Frontline Treatment Advances in Advanced Bladder Cancer

"In the last 3 years, [we have seen] the development of new drugs, specifically combinations with immunotherapy, being brought into the first-line treatment of metastatic bladder cancer. These have completely changed the landscape of available options, as well as the treatment paradigm."

Janaki Neela Sharma, MD, assistant professor, clinical medicine, Genitourinary Medical Oncology, University of Miami Health Systems, discusses the implications of therapeutic advancements in the front line treatment of patients with advanced bladder cancer.

For decades, cisplatin and gemcitabine have been the standard chemotherapy for the treatment of patient with bladder cancer, Sharma begins. However, these agents often produced low response rates and had a short durability of effect. As a result, metastatic bladder cancer was historically challenging to manage effectively, with poor survival outcomes, Sharma explains. However, significant advancements in treatment options in the last 3 years, especially with immunotherapy combinations in the frontline metastatic setting, have transformed the management landscape, Sharma states.

Among these innovations is the development of the Nectin-4–targeted antibody-drug conjugate enfortumab vedotin-efjv (Padcev), which has redefined therapeutic approaches, Sharma notes. Patients can now be evaluated for these options with an emphasis on balancing efficacy with quality of life, given that individual patient comorbidities can impact their tolerance to different regimens, she says.

Although there is substantial experience with the toxicity profiles of traditional agents like gemcitabine and cisplatin, the adverse effects associated with enfortumab vedotin combined with pembrolizumab (Keytruda) may be unfamiliar to many practicing oncologists, Sharma notes. Yet, with experience and multidisciplinary support, these toxicities are manageable, underscoring the need for a collaborative approach to help patients benefit fully from these advanced treatments, Sharma concludes.