Systemic treatment of advanced and metastatic urothelial cancer: The landscape in Australia

Gurney, H; Clay, TD; Oliveira, N; Wong, S; Tran, B; Harris, C

Author(s): Gurney, H; Clay, TD; Oliveira, N; Wong, S; Tran, B; Harris, C;
Details: Publication Year 2023-12,Volume 19,Issue #6,Page 585-595
Journal Title: Asia-Pacific Journal of Clinical Oncology
Publication Type: Review
Abstract: The 5-year survival rate of metastatic urothelial carcinoma (mUC) is estimated to be as low as 5%. Currently, systemic platinum-based chemotherapy followed by avelumab maintenance therapy is the only first-line treatment for mUC that has an overall survival benefit. Cisplatin-based chemotherapy (usually in combination with gemcitabine) is the preferred treatment but carboplatin is substituted where contraindications to cisplatin exist. Treatment with immune checkpoint inhibitors, antibody-drug conjugates, and kinase inhibitors has not yet demonstrated superiority to chemotherapy as first-line therapy and remains investigational in this setting. A recent media release indicates that chemotherapy plus nivolumab gives an OS advantage as first-line treatment but results of this study have not yet been made public. Pembrolizumab remains an option in those having primary progression on first-line chemotherapy or within 12 months of neoadjuvant chemotherapy. The antibody-drug conjugate, enfortumab vedotin has TGA approval for patients whose cancer has progressed following chemotherapy and immunotherapy and has just received a positive Pharmaceutical Benefits Scheme recommendation. The use of molecular screens for somatic genetic mutations, gene amplifications, and protein expression is expanding as drugs that target such abnormalities show promise. However, despite these advances, a substantial proportion of patients with mUC have significant barriers to receiving any treatment, including advancing age, frailty, and comorbidities, and less toxic, effective therapies are needed.
Department(s): Medical Oncology
PubMed ID: 37727139
Publisher's Version: https://doi.org/10.1111/ajco.14001
Open Access at Publisher's Site: https://doi.org/10.1111/ajco.14001
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2023-12-15 06:03:12

Last Modified: 2023-12-15 06:07:50