Progress in the treatment of bladder cancer

12 de August de 2019

Cancer represents a major health problem. It is estimated that, in 2019, almost 280,000 people will be diagnosed with this disease in our country. These figures are higher than in previous years. The most common tumors in Spain are those of the colon, prostate, breast, lung and urinary bladder.

As the number of new diagnoses increases steadily (due to our increased life expectancy among other reasons), the survival of our cancer patients is also increasing. This is due to diagnoses in earlier stages of the disease, management in multidisciplinary teams and the incorporation of newer treatments.

In this last sense, it is worth noting the recent communication of the results of an international study in which several Spanish oncologists have participated, including Dr. Ignacio Duran of the Medical Oncology Service of the Marqués de Valdecilla University Hospital. The mentioned study refers to a new therapy for advanced bladder cancer. This tumor, when localized, is treated with local measures such as surgery, radiotherapy [alone or in combination with chemotherapy] or instillation of treatments within the bladder itself. However, once the tumor extends beyond the bladder generating metastases in other organs, treatment options have traditionally been limited to chemotherapy and with suboptimal results. More recently, immunotherapy has been added to the treatment arsenal, drugs that by activating the immune system induce an antitumor activity in those cases that have failed conventional chemotherapy. However, the benefit of immunotherapy is limited to 15-20% of patients.

The results now published in the prestigious “New England Journal of Medicine” refer to a new molecule called Erdafitinib (Balversa ™) that has demonstrated remarkable efficacy in a phase II trial in patients with advanced bladder tumors that had progressed after previous treatments. of chemotherapy and immunotherapy. The peculiarity of this new drug is that we know that its effectiveness is conditioned by the presence of specific alterations (mutations or fusions) in some genes (the so-called FGFR family). Thus, this study only included those patients whose tumors had mutations or fusions in FGFR. Hence, we could say that it is a new “targeted therapy” and that we have the ability to select those patients in which the probability of treatment success is greater. This represents an unprecedented milestone in the treatment of this disease.

Specifically in the published study, Erdafitinib was able to induce some degree of tumor reduction up to 70% of the 99 patients treated, being in 40% of cases a significant and more lasting reduction over time. It should be noted that of those patients who had received immunotherapy without responding to it, two thirds benefited from this treatment.

These results have resulted in the recent approval by the US regulatory authorities of this drug in the US representing a new treatment alternative for these patients. In Europe it is not yet available except in clinical studies.

In Cantabria, the Marqués de Valdecilla University Hospital through a collaboration of the Medical Oncology, Urology and Clinical Pharmacology Service is carrying out a Phase I study with Erdafitinib in combination with a new immunotherapeutic. Undoubtedly, the times of shortage of treatment options in this complex patient population are behind. This is good news for patients with advanced bladder cancer.