Expanding Treatment Options in Urothelial Cancer With ADCs

Scott T. Tagawa, MD, MS, FACP, FASCO, professor of medicine and Urology at Weill Cornell Medicine, and an attending physician at NewYork-Presbyterian – Weill Cornell Medical Center, discusses the potential benefits of antibody-drug conjugates (ADCs), particularly enfortumab vedotin-efjv (Padcev; EV), in urothelial cancer while acknowledging the need for more education and experience among physicians to optimize their use.

Transcription:

0:09 | It is not exactly true that ADCs are replacing cytotoxic chemotherapy across the board. First of all, when I talk to a patient, I always use the word chemotherapy when I am talking about ADCs because it is not like there are no toxicities from an ADC that are not similar to a kind of plain cytotoxic chemotherapy. They are just trade-offs in drug development, mostly having been to maximize efficacy, rather than maximize tolerability. I think there are 2 pathways, but that is not what has happened.

0:44 | But in any case, I would say for physicians, let’s say we go back to the discussion on urothelial cancer. An average hematologist/oncologist that is seeing multiple tumor types probably sees more breast cancer than urothelial cancer, and probably has used sacituzumab govitecan-hziy [Trodelvy; SG] because of breast cancer, and they get their first platinum-refractory IO progresser. We do not have any head-to-head data of [enfortumab vedotin] EV vs SG, although EV has a high level of evidence. It has already completed randomized trials. But…it is probably better to give a drug that they know how to do safely, rather than give another drug. All physicians need to learn about EV because of the major efficacy in the upfront setting.

1:44 | The message is to learn about it. There there are multiple resources, whether that is something like this, what is out there in print or online, whether it is attending conferences and meetings, whether it’s talking to a local or regional physician, that stereotypically is an academic center, but does not have to be an academic center, just someone with experience and talking to them. Then, there is also some support from the companies. Whether that is just kind of the unlabeled data that is available in the packet insurance, whether that is through the medical people like medical science liaisons, etc, or coming to do an inservice, I think there are multiple resources that are available because each of these agents is there for a reason because there are major benefits to patients. We do not want the patients to lose out just because of a practice that does not have experience.

2:40 | I think that it is important for that to happen, and for patients and families and caregivers to kind of know about, what’s the landscape? I do not want to fault a physician for administering cisplatin/gemcitabine because that is what they are used to for a frontline urothelial patient [with cancer], but hopefully, that message will go out there, both to physicians as well as patients and say, hey, wait a minute, what about this? Then eventually as education pours out there, knowing the available data, knowing which drugs, [which] drug combinations are available, and how to give them safely will translate to the masses.