Immunotherapy With Checkpoint Inhibitors in FGFR-Altered Urothelial Carcinoma

David J Benjamin1, Nataliya Mar2, Arash Rezazadeh Kalebasty2

  • 1Medical Oncology, Hoag Family Cancer Institute, Newport Beach, CA, USA.

Insights

Immune checkpoint inhibitors (ICIs) revolutionized metastatic urothelial cancer (mUC) treatment. Combining erdafitinib with ICIs may improve outcomes for patients with FGFR+ mUC, addressing potential ICI resistance.

Area of Science:

  • Oncology
  • Genitourinary Cancer
  • Cancer Therapeutics

Background:

  • Metastatic urothelial cancer (mUC) treatment options were limited until immune checkpoint inhibitors (ICIs) emerged in 2016.
  • Molecular profiling identified subtypes of bladder cancer, including those with fibroblast growth factor receptor (FGFR) alterations.
  • Erdafitinib, a pan-FGFR inhibitor, gained approval in 2019 for advanced UC.

Purpose of the Study:

  • To investigate the potential for improved treatment outcomes in FGFR-altered metastatic urothelial cancer.
  • To explore the combination of erdafitinib and ICIs in mUC treatment.
  • To address the observed inferior response to ICIs in advanced FGFR+ UC.

Main Methods:

  • Review of current treatment paradigms for mUC.
  • Analysis of molecular subtypes, focusing on FGFR alterations.
  • Examination of ongoing clinical trials, including Phase IB/II studies combining erdafitinib with ICIs.

Main Results:

  • Evidence suggests potential for reduced efficacy of ICIs in FGFR-altered mUC.
  • The tumor microenvironment may play a role in ICI response in FGFR+ mUC.
  • Ongoing trials are evaluating combination therapies for enhanced efficacy.

Conclusions:

  • The combination of erdafitinib and ICIs shows promise for more robust and durable responses in FGFR+ mUC.
  • Targeting FGFR alterations alongside immune modulation represents a potential advancement in mUC therapy.
  • Further research and clinical trials are crucial to validate these findings.

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