ASCO GU Clinical Research of Interest in Locally Advanced or Metastatic UC

Jeanny B. Aragon-Ching, MD, FACP, Clinical Program Director of Genitourinary Cancers at Inova Schar Cancer Institute, highlights the clinical trials being presented at the ASCO GU symposium, as well as other research, that could be standard-of-care-changing for patients with locally advanced or metastatic urothelial carcinoma.

Dr. Aragon-Ching: I think one of the newer ADCs that are up and coming now, and it is disitamab vedotin, so the target here is HER2. So it’s now ongoing in several clinical trials, phase two right now with or without pembrolizumab, and in fact, they’re launching a phase three trial in the first line, frontline setting metastatic urothelial cancer and this is in combination, so I call it DV, short for disitamab, DV plus pembrolizumab compared to actually standard of care chemotherapy, and patients could have progressed on or moved on to avelumab maintenance. So that’s the comparator arm is the chemotherapy standard of care first line compared to DV plus pembro. So that’s going to be a phase three trial.

And other than that, there’s a lot of cohort analysis and actually, presentation in the upcoming GU ASCO for SG in combination with pembro, and I would say the biggest population of patients that are really being looked at is, apart from the first line, is really narrowed down to that cisplatin ineligible patients because we know that this population is really an increased unmet need in metastatic urothelial cancer because up to a quarter of patients may not even see through first line treatment because the population of patients we have unfortunately tends to be older, frail, they have a lot of comorbidities, and there’s a high attrition rates. So meaning even patients who see through first line therapy, if that didn’t work, a lot of patients are not able to see through second line therapy.

So that’s I think where a lot, and we are seeing a lot of trials looking at the cis ineligible patient population because it matters. That is where a lot of the trials are focusing now. Another trial that we’re eagerly awaiting results of is EV-302, which is the EV plus pembro combination compared again to chemo. So this is the first line frontline setting, and ultimately, it will try to answer the question, can we do without chemotherapy because remember, as we said earlier, the standard of care remains to be chemotherapy upfront for all patients who are appropriate for chemotherapy followed by avelumab maintenance. So that’s our current standard of care. So the question is, is there going to be a group of patients who can do without chemotherapy and go straight to EV with pembrolizumab combination? So that trial’s going to try and answer that question.

View Dr. Aragon-Ching’s other comments on locally advanced or metastatic urothelial carcinoma, including Maintenance Therapy Options, Disease Progression After Maintenance Therapy, and The Future of Personalized Care.