Refining existing knowledge and management of bladder cancer

For the management of bladder cancer, 2018 has been characterized by deepened knowledge on the molecular basis of invasive bladder cancer and its potential interaction with existing therapies, optimization of the use of immune checkpoint inhibitors, and emerging early signals on new therapeutic classes for advanced disease.

Key advances

• The Cancer Genome Atlas performed a comprehensive characterization of muscle-invasive bladder cancer (MIBC) in a large cohort and proposed a framework of molecular subtypes with potential therapeutic approaches to inform future clinical trial design¹.

• The phase III RAZOR trial reported noninferior 2-year progression-free survival between robot-assisted radical cystectomy and open radical cystectomy².

• The phase II PURE-01 study reported that patients with MIBC and high programmed cell death 1 ligand 1 (PD-L1) expression had the highest response rates to neoadjuvant pembrolizumab⁵, warranting further evaluation in larger cohorts.

• The phase III IMvigor211 trial did not report an overall survival benefit with atezolizumab over cytotoxic chemotherapy in locally advanced or metastatic urothelial carcinoma⁷.

• Preliminary phase II findings demonstrated the efficacy of the fibroblast growth factor receptor 3 (FGFR3) inhibitor erdafitinib in metastatic urothelial cancer, leading to FDA Breakthrough Therapy Status for this drug¹⁰.