Utilization of systemic therapy for treatment of advanced urothelial carcinoma: Lessons from real world experience

Area of Science:

• Oncology
• Medical Therapeutics

Background:

• Metastatic bladder cancer (MBC) has a poor prognosis, with limited systemic therapy uptake in real-world settings.
• Significant patient attrition occurs between first- and second-line treatments, and cisplatin is underutilized despite superior efficacy compared to carboplatin.
• Challenges include chemotherapy toxicity, patient comorbidities, and socioeconomic factors impacting treatment access.

Purpose of the Study:

• To discuss strategies for overcoming barriers to effective systemic therapy in metastatic bladder cancer.
• To explore novel therapeutic approaches and optimize existing treatment paradigms for improved patient outcomes.

Main Methods:

• Discussion of current treatment challenges and review of emerging therapeutic strategies.
• Analysis of factors influencing systemic therapy utilization in metastatic bladder cancer patients.
• Consideration of novel agents and treatment sequencing for improved patient management.

Main Results:

• Neoadjuvant cisplatin-based therapy can prevent or delay metastatic disease.
• Avelumab maintenance therapy can mitigate patient attrition from first- to second-line treatment.
• Novel agents like enfortumab vedotin, erdafitinib, and sacituzumab govitecan show promise for earlier lines of therapy.

Conclusions:

• Optimizing neoadjuvant and adjuvant therapies is crucial for preventing metastatic bladder cancer.
• Maintenance therapy and novel systemic agents can improve treatment continuation and efficacy.
• Addressing affordability and accessibility is essential for equitable patient care in metastatic bladder cancer.