Administering Novel Strategies, Managing Toxicities in Bladder Cancer Care: Insights From Dr. Karine Tawagi

In the fourth panel of the Advancements in Oncology event, held on Saturday, June 1, The Oncology Brothers, Rahul Gosain, MD, MBA, and Rohit Gosain, MD, sat down with Karine Tawagi, MD, of the University of Illinois Chicago.

Together, they delved into the latest developments in bladder cancer treatment, beginning with the groundbreaking presentation of the EV-302 study at the European Society for Medical Oncology 2023 Congress. While the excitement at the 2024 American Society of Clinical Oncology Annual Meeting may not be as strong in bladder cancer, the implications for clinical practice are substantial.

Revolutionizing Treatment Paradigms

Bladder cancer, in both its metastatic and muscle-invasive forms, has seen notable advancements, they agreed. The importance of involving urologists up front cannot be overstated, particularly with the expanding array of options aimed at bladder preservation. In the context of muscle-invasive disease, emerging data underscore the significance of adjuvant therapy.

However, it is in the realm of advanced disease where the most significant strides have been made. “The introduction of [enfortumab vedotin (EV)]/pembrolizumab as a standard of care, based on the EV-302 trial, has revolutionized treatment paradigms,” noted Dr. Tawagi. Additionally, “nivolumab/gemcitabine-cisplatin has emerged as another viable option for metastatic bladder cancer patients.”

Dr. Tawagi highlighted the compelling data supporting the efficacy of EV/pembrolizumab in the majority of patients with metastatic urothelial carcinoma. “Despite concerns regarding long-term toxicity, it remains a preferred choice for most cases.” However, “alternatives like nivolumab/gemcitabine-cisplatin may be considered in select scenarios, pending further research.”

High Tumor Burden, Toxicities

The discussion also touched on the management of high tumor burden cases. While chemotherapy remains an option, “EV/pembrolizumab continues to be favored due to its high response rates and potential for rapid responses,” Dr. Tawagi stated.

Considering the side effect profile, adjustments in treatment strategies have been made. “Neuropathy, a significant dose-limiting side effect, prompts some providers to advocate for initiating treatment at lower doses,” she explained. Monitoring glucose levels is crucial, as “hyperglycemia can lead to serious complications.”

Skin toxicity and other rare side effects necessitate careful management and may require treatment modifications.

View the next segment of this session: Personalized Oncology: Dr. Karine Tawagi Discusses the Future of Bladder Cancer Treatment Decision-Making With ctDNA.