High-grade Urothelial Cancer

Guru Sonpavde

Answers to questions: 1. In absence of trial, I would institute docetaxel (without enthusiasm). 2. In presence of FGFR2/3 activating genomic alteration, I would have administered erdafitinib as second-line therapy when patient recurred after radical cystectomy (before pembrolizumab). 3. With current data, no adjuvant therapy is proven, but CHECKMATE274 data are eagerly awaited (Nivolumab improved DFS in all-comers and PD-L1+ patients according to press release). 4. Current optimal systemic therapy for CNS metastases is unclear. Currently, I advise controlling CNS lesions with palliative radiation and institute systemic therapy immediately thereafter. 5. Estimated survival is dismal with CNS metastases (probably worse than liver metastasis, a known poor prognostic factor).