Maintenance Therapy for Locally Advanced or Metastatic UC

Jeanny B. Aragon-Ching, MD, FACP, Clinical Program Director of Genitourinary Cancers at Inova Schar Cancer Institute, explains what the treatment approach should be for advanced or metastatic urothelial carcinoma after a response to chemotherapy.

Dr. Aragon-Ching: Any patient who’s newly diagnosed, if they have locally advanced metastatic urothelial cancer, locally advanced that’s not resectable, and of course, frank metastatic urothelial cancer, the first thing we do is we try to determine, are they cisplatin eligible or not, and whether or not they’re cisplatin eligible, if they are carboplatin eligible, they get chemotherapy. Now there’s going to be a subset few patients who would be ineligible at all for any platinum, and I would say right now, that’s maybe the only subgroup population of patients who may not be eligible for chemotherapy at all.

But all the rest of the patients who are chemotherapy eligible would get either GemCis or GemCarbo, and then if they achieve any kind of response, CR, PR, or at least stable disease, then they move on to avelumab maintenance, which is an immunotherapy with the idea being if we can get good response or at least stable disease from upfront chemotherapy, then we can maintain such response for a longer period of time with immunotherapy because it’s inconceivable to give chemotherapy forever. So unfortunately, patients will not be able to tolerate that. Now, on the other hand, if there was ever any clinical trial that would be appropriate for such patients, we also advocate for that because the only way to move forward with standard of care options is for patients to be able to avail of clinical trial options.

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