Key Treatment Data in Urothelial Carcinoma

Opinion
Video

A medical oncologist specializing in urothelial carcinoma reviews key data on erdafitinib, enfortumab vedotin, and sacituzumab govitecan.

Case 1: A 72-Year-Old Man with Metastatic Urothelial Carcinoma

Initial Clinical Presentation: 

  • A 72-year-old man presented to the clinic with complaints of dizziness and hematuria.
  • PMH: Obesity (BMI) and poorly controlled type 2 diabetes (blood sugar, 200 mg/dL)
  • SH: Patient does not smoke and occasionally drinks, in social settings.

Initial Clinical Workup: 

  • CT of chest, abdomen, and pelvis revealed a 3.5-cm mass in the bladder and multiple liver metastases
  • ECOG PS 1
  • eGFR > 60 mL/min (cisplatin-eligible kidney function)
  • Biopsy/pathology confirmed stage IV metastatic urothelial carcinoma
  • Molecular testing: FGFR2/3 mutation and fusionnegative

Initial Treatment and Disease Progression:

  • Patient received platinum-based chemotherapy with cisplatin.
    • Experiences platinum-based peripheral neuropathy (paresthesia) that interrupted the patient’s quality of life.
      • Neuropathy was low grade AE (Grade 1)which improved to Grade 0 with supportive care.
    • Partial response after 4 cycles of cisplatin; ECOG PS 1
    • Imaging showed no growth of existing lesions or new lesions after 4 cycles ​
  • Followed with IO maintenance with avelumab 800 mg IV infusion over 60 minutes every two weeks.
    • Following 9 cycles, patient achieved partial response in the lung and bladder.
    • Liver function tests, CrCl, and other labs were within normal limits
    • No infusion reactions
    • 5 months later, disease progression is confirmed
  • Patient was initiated on sacituzumab govitecan 10 mg/kg on Days 1 and 28 for 21-day continuous treatment cycle.
    • Patient experiences grade 3 neutropenia at the time of schedule treatment.
    • Delay dosing by 2 weeks until recovery to less than grade 1. Managed with 25% dose reduction and administration of G-CSF.
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