Category 1 Choices Available for Metastatic Bladder Cancer

Chandler H. Park, MD, a medical oncologist at Norton Cancer Institute and advisory dean/professor at University of Louisville in Kentucky, discusses the Category 1 treatment options for metastatic bladder cancer from the NCCN guidelines.

Park notes that bladder cancer is similar to small cell lung cancer due to its rapid spread. In this setting, the NCCN Category 1 choices include enfortumab vedotin (Padcev) plus pembrolizumab (Keytruda); cisplatin and gemcitabine plus nivolumab (Opdivo) followed by nivolumab maintenance; and chemotherapy followed by avelumab (Bavencio) maintenance. Avelumab, which was evaluated in the JAVELIN Bladder 100 trial (NCT02603432), is given to patients who achieve stable disease or better response.

TRANSCRIPTION

0:10 | Metastatic urothelial cancer [has a] very tough patient population. Whenever I have my resident physicians and fellows, I compare it to small cell lung cancer. And the reason is, the cancer spreads so fast, and so you want to make sure that you get the best treatment for our patients. We have something called the NCCN Category 1. We're very fortunate for GU cancer [because] we have 3 NCCN Category 1 [options]. We have enfortumab vedotin with pembrolizumab [based on] EV-302 [NCT04223856], that's considered category 1. For our patients [who] are considered cisplatin eligible, we have cisplatin, gemcitabine, and nivolumab. And the other one that's actually, it's also in terms of Category 1 in NCCN guidelines, is the JAVELIN Bladder 100 paradigm.

1:15 | The JAVELIN Bladder 100 paradigm is, you do 4 to 6 cycles of chemotherapy, whether it be cisplatin/gemcitabine, carboplatin/gemcitabine, or also dose-dense MVAC [methotrexate, vinblastine, doxorubicin, and cisplatin]. This is the only one of the 3 where you can do dose-dense MVAC for [the] first line. Then after 4 to 6 cycles of treatment, if the patients have a stable disease, partial response, or complete response, we do maintenance immunotherapy. So the maintenance immunotherapy is avelumab, which is a checkpoint inhibitor.