ASCO: Outcomes of Patients With Metastatic Urothelial Carcinoma Following Discontinuation of Enfortumab-Vedotin
Dr. Mossanen: Welcome to PracticeUpdate, today we are going to be discussing metastatic urothelial carcinoma. I have Dr. Sonpavde with me. I’m Dr. Mossanen. I thought it would be helpful to have you summarize some of the key points from outcomes of patients with metastatic urothelial cell carcinoma that have had discontinuation of enfortumab vedotin.
Dr. Sonpavde: Thank you, Matt. We wanted to highlight outcomes for patients who had discontinued enfortumab. This is really not outcomes of patients on enfortumab, this is after discontinuing enfortumab. We wanted to look at, if these patients have poor outcomes or do these patients still do reasonably well because they have gotten all the way to enfortumab third-line therapy. Which, of course, enfortumab is approved in the post-platinum and post-PD-1 setting, and with enfortumab already you are at third-line therapy.
Some of these patients may have indolent disease and that is how they get to third-line. We wanted to examine the issue of post-enfortumab patients. We assembled 63 patients from multiple institutions that had discontinued enfortumab for various reasons, mostly for progression and what was seen is that the outcomes of these patients was quite poor. The overall median survival was only 24 weeks and only around half of all patients received some form of treatment post-enfortumab. Which suggests that if patients are poor performance status, they are late line of therapy, and therefore this is really a setting where we highlight the unmet needs of this patient population group when new agents are necessary.
Dr. Mossanen: What are some of the options then for patients that are in that space? Is there another agent or combination therapy being studied?
Dr. Sonpavde: What we have in that space is erdafitinib, that is an FGFR inhibitor. But of course, that is only approved and active in patients with somatic activating FGFR3 or FGFR2 mutations or fusions, that is only 15% to 20% of patients. But in most patients who are post-platinum checkpoint inhibitor and then enfortumab, we do not have highly effective options, so off protocol in the community out there, people are doing various drugs like taxanes or pemetrexed. Clinical trials, of course, when available should be high on the list. This is what is going on out in the community and this is what we saw in our group also. Which is about, half the patients were getting on something either a trial or a taxane or pemetrexed. Some people were repeating a checkpoint inhibitor and really the strategy of repeating a checkpoint inhibitor after prior checkpoint inhibitor is unclear and needs to be teased out. But people are doing many different things at this time in the community in the absence of a trial.
Dr. Mossanen: Well, thank you very much Guru, for summarizing that finding and explaining a little bit about what the future is going to hold for patients and this, I think very challenging space.
Dr. Sonpavde: Thank you Matt.
Click on any of these tags to subscribe to Topic Alerts. Once subscribed, you can get a single, daily email any time PracticeUpdate publishes content on the topics that interest you.
Visit your Preferences and Settings section to Manage All Topic Alerts
Additional Info
Disclosure statements are available on the authors' profiles: