Finally, I want to highlight one of this year’s speakers at the LUGPA meeting, Dr. Will Flanary also known as Dr. Glaucomflecken. While perhaps best known for satirical comedy highlighting the stereotypes of medical specialties – check out his take on the first day of urology – he also brings incredible lived experience to the patient role in health care. Whether you’re at LUGPA or couldn’t make it, take a moment to dive beyond the humor and appreciate all that he brings to the table.

While I know we’ve gotten into the weeds with systemic therapy that is typically given by medical oncologists, there were a number of studies presented at ESMO 2023 looking at novel treatment approaches for patients with NMIBC. In the linked discussion, Dr. Jim Catto discusses three abstracts which look at the use of TAR-200 (intravesical slow-release gemcitabine). TAR-210 (intravesical slow-release erdafinitib), and, in THOR-2, a comparison of erdafinitib with intravesical chemotherapy in patients with BCG-refractory NMIBC.

I want to also highlight the second cohort of the THOR trial. As presented at this year’s ESMO meeting, cohort 2 compared erdafinitinb and pembrolizumab in patients who had not yet received immunotherapy. In this group, while PFS and response rate were higher with erdafitinib, the primary outcome of overall survival was similar between the two groups. Regardless, this study highlights another potential treatment option for this patient population with a generally poor prognosis.

The second study I want to highlight looks at treatment options in patients with metastatic urothelial carcinoma who have already received treatment. This study, THOR, enrolled two cohorts of patients. The first cohort provide a comparison between erdafinitinb and chemotherapy in those who had previously received immunotherapy showed the benefit of erdafinitinb. The primary results of this were presented at ASCO 2023 though the publication was released to coincide with Dr. Loriot’s presentation of subgroup data at ESMO 2023. In patients with FGFR mutations, erdafinitib improved overall survival by more than 4 months. Importantly, Dr. Loriot showed that this effect was seen in essentially all patient groups and across all examined FGFR alterations.

In this podcast from the EAU, Dr. Benjamin Pradere and Prof. Thomas Powles discuss the EV-302 trial that Dr. Powles presented at ESMO 2023. EV-302 is a randomized phase 3 trial which evaluated the combination of enfortumab vedotin and pembrolizumab as compared to combination chemotherapy (our current standard of care) as first-line treatment for patients with advanced or metastatic urothelial cancer. The top-line results demonstrated a near doubling of progression free survival (6.3 to 12.5 months and over overall survival (16.1 to 31.5 months). I think this podcast offers an insightful look into the nuances of this trial and these data from the first author himself.