Systemic treatment of advanced and metastatic urothelial cancer: The landscape in Australia

Author:

Gurney Howard1ORCID,Clay Timothy D.234,Oliveira Niara56,Wong Shirley7,Tran Ben8,Harris Carole910

Affiliation:

1. Faculty of Medicine Health and Health Sciences Macquarie University Sydney NSW Australia

2. St John of God Subiaco Hospital Subiaco Washington Australia

3. Icon Cancer Care, Midland Washington Australia

4. School of Medical and Health Sciences Edith Cowan University, Joondalup Washington Australia

5. Mater Hospital Brisbane Mater Misericordiae Ltd. South Brisbane Queensland Australia

6. School of Clinical Medicine Mater Clinical Unit The University of Queensland Brisbane Queensland Australia

7. Department of Medical Oncology Western Health Melbourne Victoria Australia

8. Department of Medical Oncology Peter MacCallum Cancer Centre Melbourne Victoria Australia

9. Department of Medical Oncology St George Hospital Kogarah NSW Australia

10. Faculty of Medicine University of New South Wales Kensington NSW Australia

Abstract

AbstractThe 5‐year survival rate of metastatic urothelial carcinoma (mUC) is estimated to be as low as 5%. Currently, systemic platinum‐based chemotherapy followed by avelumab maintenance therapy is the only first‐line treatment for mUC that has an overall survival benefit. Cisplatin‐based chemotherapy (usually in combination with gemcitabine) is the preferred treatment but carboplatin is substituted where contraindications to cisplatin exist. Treatment with immune checkpoint inhibitors, antibody‐drug conjugates, and kinase inhibitors has not yet demonstrated superiority to chemotherapy as first‐line therapy and remains investigational in this setting. A recent media release indicates that chemotherapy plus nivolumab gives an OS advantage as first‐line treatment but results of this study have not yet been made public. Pembrolizumab remains an option in those having primary progression on first‐line chemotherapy or within 12 months of neoadjuvant chemotherapy. The antibody‐drug conjugate, enfortumab vedotin has TGA approval for patients whose cancer has progressed following chemotherapy and immunotherapy and has just received a positive Pharmaceutical Benefits Scheme recommendation. The use of molecular screens for somatic genetic mutations, gene amplifications, and protein expression is expanding as drugs that target such abnormalities show promise. However, despite these advances, a substantial proportion of patients with mUC have significant barriers to receiving any treatment, including advancing age, frailty, and comorbidities, and less toxic, effective therapies are needed.

Funder

Merck Healthcare KGaA

Publisher

Wiley

Subject

Oncology,General Medicine

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