An evaluation of the efficacy and safety of erdafitinib for the treatment of bladder cancer

ABSTRACT

Introduction

Treatment of unresectable or metastatic urothelial carcinoma (UC) has historically relied upon platinum-based chemotherapy and, more recently, immune checkpoint inhibitors. When tumors progress despite those therapies, remaining effective options are limited.

Areas covered

In this review, the authors review the advancement in genomic targets in UC, most notably fibroblast growth factor receptor (FGFR). FGFR has been identified as a target in UC as it is commonly genomically altered (activating mutations or fusions), and may be enriched in UC subtypes that are relatively resistant to immune checkpoint blockade. Erdafitinib, a potent and selective inhibitor of FGFRs, represents the first targeted therapy approved for the treatment of UC by virtue of a confirmed response rate of 40% in an open-label, single-armed phase II trial in molecularly selected tumors. The authors provide their expert opinion of its approval and place it in the context of the current and forthcoming treatment strategies for metastatic UC.

Expert opinion

The approval of erdafitinib provides clinicians with an important new treatment option for patients with metastatic UC and projects forward into an era of enhanced molecular precision in identifying effective therapies in UC.

KEYWORDS:

• Urothelial carcinoma
• bladder cancer
• fibroblast growth factor receptor
• targeted therapy

Article highlights

• Following platinum-based chemotherapies, few options exist for treatment of progressive unresectable or metastatic urothelial carcinoma (UC)

• Fibroblast Growth Factor Receptor (FGFR) may be mutated or fused in UC and presents a target for treatment.

• Erdafitinib, as a potent and selective inhibitor of FGFR, represents the first approved molecularly-selected targeted therapy for UC and marks the beginning of an era of biomarker-driven drug discovery for UC.

• The authors put erdafitinib in context with other emerging therapies including antibody-drug conjugates and immune checkpoint inhibitors.

Declaration of Interest

ST Tagawa has received research funding through via Weill Cornell Medicine from Janssen Pharmaceuticals, Merck & Co., Genentech, Novartis, Pfizer Inc and Bayer. He has further received honoraria from Janssen Pharmaceuticals, Sanofi, Pfizer Inc, QED Therapeutics and Bayer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

One referee declares that they have received research grants from Boehringer Ingelheim, Bayer, Onyx-Amgen, Pfizer, Merck and Co, Sanofi, AstraZeneca and Celgene. They also serve and have received advisory board fees from Pfizer, Bristol-Myers Squibb, Genentech, EMD Serono, Novartis, Merck and Co, Sanofi, Seattle Genetics/Astellas, AstraZeneca, Exelixis, Janssen Pharmaceuticals, Amgen, Eisai and the National Comprehensive Cancer Network (NCCN). Furthermore, they have received travel expenses from Bristol-Myers Squibb and AstraZeneca as well as speaking fees from the Physicians Education Resource (PER), Onclive, Research to Practice, Clinical Care Options as well as writing fees from Uptodate. Finally, they have served on the Steering committee of trials sponsored by Bristol-Myers Squibb, AstraZeneca, Bavarian Nordic, Debiopharm and QED Therapeutics. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This manuscript has not been funded.