We have detected that you are using an Ad Blocker. PracticeUpdate is free to end users but we rely on advertising to fund our site. Please consider supporting PracticeUpdate by whitelisting us in your ad blocker.
We have sent a message to the email address you have provided, . If this email is not correct, please update your settings with your correct address.
The email address you provided during registration, , does not appear to be valid. Please update your settings with a valid address before to continue using PracticeUpdate.
Please provide your AHPRA Number to ensure that you are given the correct level of access to our site.
Explore
Bladder Cancer
Center of Excellence
In an effort to better serve our users, we have streamlined our content offering. As a result, we no longer publish new content or update existing content in Bladder Cancer. Visit the 'Content & Subscriptions' tab of your Settings page at any time to update your Dashboard or Newsletter Subscription preferences to continue to see news and information that interests you most.
In an effort to better serve our users, we have streamlined our content offering. As a result, we no longer publish new content or update existing content in Bladder Cancer. Visit the 'Content & Subscriptions' tab of your Settings page at any time to update your Dashboard or Newsletter Subscription preferences to continue to see news and information that interests you most.
You can find your saved items on your dashboard, in the "saved" tab.
You've recommended your first item
Your recommendations help us improve our content suggestions for you and other PracticeUpdate members.
You've subscribed to your first topic alert
What does that mean?
Each day, we'll check to see if new items have been published to the topics you're subscribed to, and we'll send you one email with all of the new items from that day.
We'll keep all topic alert notifications available on your dashboard for 30 days, to make sure you don't miss anything.
Lastly, whenever you have unread items in the topics you've subscribed to, the "Alerts" icon will light up in the main menu. Just click on the bell to see your five most-recent, unread notifications.
Sign in to PracticeUpdate
Only registered members have full access to PracticeUpdate content.
No comments yet, be the first to start the discussion!
Guru Sonpavde
Apr 10, 2021
To summarize, this is a relatively young 59 yo female treated with neoadjuvant cisplatin/gemcitabine followed by radical cystectomy who progressed within a year with bone and lung metastases. Tumor PD-L1 expression is low. Given this is a second-line post-platinum progressive setting by conventional definition (since progressed within a year of last peri-op chemo), pembrolizumab alone is reasonable, since the phase III KEYNOTE045 trial did demonstrate benefit regardless of PD-L1 status. Tumor genomics should be obtained and if an activating FGFR3/2 mutation/fusion is found, erdafitinib is an option for the post-platinum progressive disease setting. The optimal sequencing of post-platinum erdafitinib and PD1/L1 inhibitors is unclear; contrasting data suggest PD1/L1 inhibitors may exhibit similar or lower activity in patients with somatic FGFR3/2 alterations (as opposed to those with wild type FGFR3/2). Enfortumab Vedotin is currently approved for third line therapy following platinum and PD1/L1 inhibitors. Sacituzumab Govitecan, a novel antibody drug conjugate is emerging and could become available for use in the clinic this year (awaiting regulatory review of phase II trial showing a response rate 27% in post-platinum and PD1/L1 inhibitors). Bone protective agents (denosumab or zoledronic acid) with calcium + vitamin D orally should be added unless there is a contraindication. Clinical trials should be considered a preferred option if available (combination VEGF + immune checkpoint inhibitors appear promising).
Dec 05, 2024
Pending Moderator approval.
Are you sure you want to delete this comment? This can't be undone.
Guru Sonpavde
Apr 10, 2021
Dec 05, 2024
Pending Moderator approval.