Dr Sonpavde on the Future of Treating Bladder Cancer

Guru P. Sonpavde, MD, medical director, Genitourinary (GU) Oncology, assistant director, the Clinical Research Unit, the Christopher K. Glanz Chair, Bladder Cancer Research, AdventHealth Cancer Institute, discusses the future of bladder cancer treatment, including potential novel targets and further research with immunotherapy and antibody-drug conjugates (ADCs).

The future of bladder cancer management will have many developments to look forward to, Sonpavde begins, including data from the phase 3 CheckMate901 trial (NCT03036098). This study is an open-label, randomized trial of nivolumab (Opdivo) and ipilimumab (Yervoy) or standard-of-care (SOC) chemotherapy in the form of gemcitabine plus cisplatin vs SOC chemotherapy alone in cisplatin-ineligible patients with previously untreated unresectable or metastatic urothelial cancer. Notably, this trial launched a sub-study that compared gemcitabine plus cisplatin vs gemcitabine plus cisplatin and nivolumab in cisplatin-eligible patients with treatment-naïve unresectable or metastatic urothelial cancer. Sonpavde says results from this trial are expected in the future.

Moreover, novel targets in urothelial cancer are looking exciting on the horizon, including HER2, Sonpavde expands. Disitamab vedotin (RC48-ADC), a novel ADC, showed promising activity in patients with HER2-positive urothelial cancer by immunohistochemistry, he says. Disitamab vedotin has been combined with PD-1 inhibition in patients with HER2-positive disease and will be further examined in patients with previously untreated HER2-positive urothelial cancer in a phase 3 trial (NCT05911295) in combination with pembrolizumab (Keytruda) compared with gemcitabine and platinum chemotherapy, Sonpavde explains. This trial is also an exciting direction to go with this novel target, he notes.

Furthermore, at Dana-Farber Cancer Institute, a phase 1 trial (NCT04724018) is evaluating the combination of the ADCs enfortumab vedotin-ejfv (Padcev) and sacituzumab govitecan-hziy (Trodelvy) in patients with advanced urothelial carcinoma, Sonpavde continues. This combination is exciting given the different membrane targets and the different payloads in these agents, he adds. The data from this trial are anticipated, as this combination could generate a high response rate because of the agents’ non-overlapping targets, Sonpavde concludes.