Sylvester Annual Oncology Update Highlights Different Perspectives in Bladder Cancer, Other Treatment Areas

Janaki Neela Sharma, MD

Janaki Neela Sharma, MD, sat down with OncLive^® to share her key takeaways from the Sylvester Comprehensive Cancer Center 2024 Annual Oncology Update. In the interview, she expanded on the presentations given, including a crossfire on bladder cancer that she participated in during the event.

Furthermore, Sharma provided insights and key updates on the current treatment of bladder cancer, specifically highlighting the impact that treatment with enfortumab vedotin-ejfv (Padcev) in combination with pembrolizumab (Keytruda) has made in the frontline setting for patients with advanced disease. She also delved into the importance of knowing the toxicities that accompany new treatment approaches and the responsibility oncologists have to understand them.

Sharma is an assistant professor of clinical medicine in Genitourinary Medical Oncology at the University of Miami Health Systems in Florida. You can read more from her in an additional interview with OncLive.

OncLive: You participated in the Sylvester Comprehensive Cancer Center 2024 Annual Oncology Update. What were your key takeaways from the event?

Sharma: It was wonderful to have people from other institutions because it allowed us to see how we do things differently [by] institution, how we interpret data differently, how we use [data], and how we apply that to [treating] our patients. It was also lovely to hear about some of the clinical innovations happening at other institutions.

I learned a bit about what's going on in gastrointestinal [GI] cancers, and the science has advanced since I trained and last treated [patients with] GI cancers about 10 years ago, so that was refreshing. That is probably the best part of it. In addition to the institutional crossfire in our own areas of specialty, it's helpful to know where the general field of oncology is going in each of the subspecialties; [the event] was a nice refresher. This helps us to learn disease-specific treatments [based on] what other people are doing in different diseases.

What was the goal of your crossfire session with Jingsong Zhang, MD, PhD, of Moffitt Cancer Center, on updates and clinical scenarios in bladder cancer?

For many years, we've used the same chemotherapy for bladder cancer: cisplatin and gemcitabine. [These agents have generated] abysmal response rates and durability of response. Therefore, bladder cancer was a rapidly fatal disease when it was metastatic for the majority of my training and the majority of my practice years. In the last 3 years, there has been 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.

What have been the implications of these advances in the frontline treatment of advanced bladder cancer?

There have been dramatic advances in the treatment of metastatic bladder cancer in the frontline setting. The development of an antibody-drug conjugate [ADC] like enfortumab vedotin that has a specific target [Nectin-4] that's overexpressed in bladder cancer [has been] game-changing. We should carefully evaluate our patients and make decisions based, to some extent, on quality of life and toxicity considerations, as a patient's underlying comorbidities may affect how they respond in terms of the adverse effect profile of a particular regimen.

As providers, we have a significant duration of experience dealing with the toxicity profiles from gemcitabine and cisplatin, but the toxicities from enfortumab vedotin [plus pembrolizumab (Keytruda)] are relatively new to most providers. Although those toxicities may seem more daunting, they're actually quite manageable. We have to get used to how to manage them and bring in other providers as needed to help us with the management of some of these toxicities unique to ADCs.

Were there other presentations that caught your eye at the Sylvester Comprehensive Cancer Center 2024 Annual Oncology Update?

There was a great presentation from the Gi group on what they're doing with liver transplantation for metastatic GI malignancies. It was shocking because I didn't even realize that there was such a novel application of transplantation [leading to] remarkable responses. Although the patients were all highly selected and [included] at a very small number, that is the kind of practice-changing science I would love to see more.