Editorial
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Dec 24, 2020; 11(12): 976-982
Published online Dec 24, 2020. doi: 10.5306/wjco.v11.i12.976
Practice change in the management of metastatic urothelial carcinoma after ASCO 2020
Pablo Gajate, Javier Torres-Jiménez, Carolina Bueno-Bravo, Felipe Couñago
Pablo Gajate, Javier Torres-Jiménez, Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
Carolina Bueno-Bravo, Urology Department, Hospital Universitario Infanta Sofia, Madrid 28703, Spain
Felipe Couñago, Radiation Oncology Department, Hospital Universitario Quirónsalud Madrid, Hospital La Luz, Universidad Europea de Madrid, Madrid 28028, Spain
Author contributions: Gajate P, Torres-Jiménez J, Bueno-Bravo C, and Couñago F wrote the paper.
Conflict-of-interest statement: Gajate P has served as an advisor for Roche and Janssen, has served as a speaker for Pfizer, Roche and Janssen. Torres-Jimenez J, Bueno-Bravo C and Couñago F have nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pablo Gajate, MD, Staff Physician, Medical Oncology Department, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo km. 9100, Madrid 28034, Spain. pgajateborau@gmail.com
Received: July 2, 2020
Peer-review started: July 2, 2020
First decision: October 23, 2020
Revised: November 1, 2020
Accepted: November 11, 2020
Article in press: November 11, 2020
Published online: December 24, 2020
Processing time: 168 Days and 20.1 Hours
Abstract

Metastatic urothelial carcinoma (mUC) is an incurable and aggressive disease. In the past decades there have been few effective treatment options that have impacted the prognosis of mUC patients. However, in the last few years, several drugs have emerged as new treatment choices that are changing the therapeutic landscape of mUC. Immune checkpoint inhibitors (ICIs) and targeted agents are useful treatment strategies that have been incorporated into our clinical practice. Nevertheless, cisplatin-based chemotherapy is still the standard of care in the first-line of metastatic disease. The results of the JAVELIN Bladder 100 phase 3 trial were presented at ASCO 2020, this trial evaluated the role of avelumab, an ICI, as maintenance therapy in patients who had not progressed after first-line platinum-based chemotherapy. The trial met its primary endpoint demonstrating an overall survival benefit with avelumab maintenance. In addition, new drugs and combinations are being evaluated to improve the outcomes of second and subsequent lines. Fibroblast growth factor receptor (FGFR) inhibitors and immunotherapy combinations were some of the strategies presented at ASCO 2020 that have shown promising results. Finally, the development of predictive biomarkers that help us in the decision-making process will be one of the most important challenges in the next years.

Keywords: Metastatic urothelial carcinoma; Immune checkpoint inhibitors; Avelumab; JAVELIN Bladder 100; FGFR inhibitors; ASCO 2020

Core Tip: The landscape of urothelial carcinoma treatment has changed significantly in the last 5 years. Several drugs with different mechanisms of action have emerged as new therapeutic opportunities. At ASCO 2020, avelumab, an immune checkpoint inhibitor, was evaluated as maintenance therapy in the JAVELIN Bladder 100 trial: This was the first clinical trial that improved overall survival in the metastatic setting since the 80s. Moreover, new drugs and combination strategies have shown their potential role as new therapeutic alternatives to increase survival in this disease which has a poor prognosis.