A roundtable discussion, moderated by Peter O’Donnell, MD, discussed the advanced urothelial treatment landscape, as well as recent trial data from ESMO 2023. Dr. O’Donnell was joined by Terence Friedlander, MD; Matthew Galsky, MD; and Jonathan Rosenberg, MD.
In the final segment of the roundtable series, the panel shares their hopes for the future of bladder cancer treatment, including novel immune checkpoint strategies, targeting strategies, and more.
Dr. O’Donnell: Let’s end with this: the crystal ball. Now we can get greedy. We’re making all these gains with this disease. What’s going to be the next transformative event? Jonathan, I’ll start with you.
Dr. Rosenberg: Honestly, I don’t know that there’s 1 necessarily on the horizon. I would love to see a novel immune checkpoint strategy to combine with EV [enfortumab vedotin] that would augment the immune response. I think that the dual antibody-drug conjugate question is really interesting and needs to be further explored. That could be the killer app here as well, in combination with immunotherapy. Those are 2 directions that I think we need to explore.
Dr. O’Donnell: Great. Matt?
Dr. Galsky: I think it might be targeting a cancer cell-intrinsic process in urothelial cancer that’s specific to urothelial cancer. A lot of the benefits that we’ve seen are targets that might be enriched in urothelial cancer, but not necessarily specific to this disease and not developed based on biology, That’s really focused on understanding the pathogenesis of urothelial cancer. I think there are some drugs in early-phase development that could fit the bill, whether or not they do, we’ll see in a couple years.
Dr. Friedlander: Yeah, I would agree with both those statements. I also think there’s opportunities moving these drugs up in the pipeline, either to the perioperative, preoperative space. Actually, Matt presented a really elegant study in which patients were allowed to keep their bladders after neoadjuvant therapy if they had a complete clinical response and they were watched very closely. Then cystectomy is a really pretty terrible thing to do to a patient. If there are ways to avoid cystectomy, allow people to keep their bladders, things like that, that’d be great.
Then we didn’t really cover a lot of the non-muscle invasive space here, but there’s been a number of developments, TAR-200, nadofaragene firadenovec, and other agents that are coming into the non-muscle invasive realm. I think those have a lot of potential to keep patients out of the operating room, off systemic therapy, really have some benefit there. There’s really opportunities kind of all around.
Dr. O’Donnell: What an exciting time for treating urothelial cancer patients right now, and I think a lot of promise for the future. Jonathan Rosenberg, Matt Galsky, Terry Friedlander, thank you all for doing this today. Thank you very much.