Guru Sonpavde: Take home messages from Puerto Rico Oncology Symposium
Guru Sonpavde, Phase I Clinical Trials Director at Advent Health Central Florida and the Chair of Bladder Cancer Research, shared a post on LinkedIn:
“Bladder cancer update – honored to present at the Florida Society of Clinical Oncology’s Puerto Rico Oncology Symposium Feb 2025 – Take home message:
1) Metastatic disease first-line therapy: EV (enfortumab vedotin)-pembrolizumab is the preferred firstline therapy for mUC, but GC (gemcitabine-cisplatin)-nivolumab (Lymph node only, LFT elevations, suboptimal DM control), gem-platinum – maintenance avelumab (frail, cisplatin-ineligible + ECOG-PS 2/comorbidities [neuropathy grade 2]) and pembrolizumab monotherapy (platinum-ineligible) can retain roles in selected patients; Impact of prior peri-op PD1/L1 inhibition on first-line mUC therapy needs more study;
2) Metastatic disease salvage therapy: Erdafitinib (a pan-FGFR inhibitor) is an option for those with somatic FGFR3 mutations/fusions following previous PD1/L1 inhibitors (more specific FGFR3 inhibitors are undergoing early development); T-Dxd is an option for HER2 IHC3+ mUC following prior therapy (Sacituzumab Govitecan indication withdrawn following negative Tropics-04 trial);
3) Neoadjuvant therapy for muscle-invasive disease: Durvalumab + neoadjuvant cisplatin-gemcitabine chemotherapy followed by adjuvant durvalumab improved both EFS and OS in the NIAGARA Phase III trial, which is expected to be practice-changing (regulatory review pending and data from other neoadjuvant chemo-IO combinations and EV+pembrolizumab are expected in the near future);
4) Adjuvant pembrolizumab improved DFS following surgery for muscle-invasive urothelial carcinoma and might be an additional option if approved (adjuvant nivolumab is already approved); Data supporting the use of tumor-informed ctDNA to identify MRD (minimal/molecular residual disease) and inform adjuvant or early systemic therapy continues to grow (await confirmatory data from IMvigor-011 Phase III trial);
5) Chemoradiation reasonable for muscle-invasive hashtag#bladdercancer in selected patients and based on patient choice (in context of limitation of high-level data); data for combination of PD1/L1 inhibitors with chemoradiation are awaited;
6) Advances in NMIBC (non-muscle invasive bladder cancer) include multiple approvals over past few years for BCG-unresponsive NMIBC with CIS: of IV pembro, intravesical BCG+NAI (IL-15 superagonist) & Nadofaragene Firadenovec- recent press release reported improved EFS for Sasanlimab (SQ PD1 inhibitor) + BCG as first-line therapy for high-risk NMIBC but data pending;
7) Clinical trials evaluating new therapies should be preferred since current therapies do not cure most patients (Multiple promising agents are on the horizon for multiple stages of the disease.”
More posts featuring Guru Sonpavde.
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ESMO 2024 Congress
September 13-17, 2024
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ASCO Annual Meeting
May 30 - June 4, 2024
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Yvonne Award 2024
May 31, 2024
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OncoThon 2024, Online
Feb. 15, 2024
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Global Summit on War & Cancer 2023, Online
Dec. 14-16, 2023