Introduction

The therapeutic landscape for urothelial carcinoma has changed significantly over the past few years with the addition of immunotherapy to platinum-based chemotherapy. Targeted therapy against FGFR (fibroblast growth factor receptor) is now also approved for the minority of patients with FGFR aberrations. Antibody drug conjugates (ADCs) are of great interest in urothelial carcinoma, with a recent FDA approval for enfortumab vedotin (EV) and others in development.

Areas covered

This review will provide an overview of treatment of advanced urothelial carcinoma and detail the various ADCs being studied in this disease.

Expert opinion

ADCs are an important therapeutic option for urothelial carcinoma. Responses to EV exceeded 40% in heavily pre-treated patients, while the response rate to EV combined with pembrolizumab in a phase 1b was ~70% in treatment-naïve patients. EV has already been approved in the United States and we await randomized data to confirm a survival benefit with EV. Meanwhile, studies of other ADCs, including in biomarker-selected populations, are ongoing. ADCs will undoubtedly play an increasing role in the management of urothelial carcinoma and will likely be offered earlier in the disease course, resulting in significant changes to treatment algorithms in urothelial cancer in the coming years.

介绍

在过去的几年中，在基于铂的化学疗法中增加了免疫疗法后，尿路上皮癌的治疗前景发生了巨大变化。现已针对少数FGFR畸变患者批准了针对FGFR（成纤维细胞生长因子受体）的靶向治疗。抗体药物偶联物（ADC）在尿路上皮癌中引起了极大的兴趣，最近FDA批准了enfortumab vedotin（EV）和其他药物的开发。

覆盖区域

这篇综述将概述晚期尿路上皮癌的治疗方法，并详细介绍正在对该疾病进行研究的各种ADC。

专家意见

ADC是尿路上皮癌的重要治疗选择。在未接受过治疗的患者中，经过大量预处理的患者对EV的响应超过40％，而在1b期阶段，与pembrolizumab联合pembrolizumab的EV响应率为〜70％。EV已在美国获得批准，我们正在等待随机数据以确认EV的生存益处。同时，正在进行其他ADC的研究，包括在生物标志物选择人群中的研究。毫无疑问，ADC在尿路上皮癌的治疗中将发挥越来越重要的作用，并且很可能会在疾病过程的早期提供，因此，未来几年尿路上皮癌的治疗方法将发生重大变化。