Sequencing in Advanced Urothelial Carcinoma

The indication for sacituzumab govitecan (Trodelvy) in previously treated patients with locally advanced or metastatic urothelial cancer was withdrawn last month after the drug failed to improve survival versus single-agent chemotherapy in the phase III TROPiCS-04 trial.

In light of this changed landscape, Joaquim Bellmunt, MD, PhD, of Dana-Farber Cancer Institute in Boston, discusses second-line treatment options.

Following is a transcript of his remarks:

Sequencing is now an issue because we have now, as mentioned, three options for first-line treatment and the point is what to do next. And then in patients who are receiving chemotherapy followed by maintenance avelumab [Bavencio], after that some patients are receiving enfortumab vedotin [EV, Padcev], and then after that receiving sacituzumab govitecan. That’s the present sequencing on that.

In patients who are receiving EV/[pembrolizumab (Keytruda)], then obviously the most rational next step — and without any data supporting that — we are giving cisplatin because we have not been using the cisplatin in first-line therapy.

Before this ASCO [American Society of Clinical Oncology], another thing that has not been presented is, we heard the press release of the TROPiCS-04, that is the sacituzumab phase III. Unfortunately, this trial was negative. And this is quite concerning because now we were going to have another drug, an ADC [antibody-drug conjugate] sacituzumab govitecan, for sequencing.

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