Fast Five Quiz: Management of Metastatic Bladder Cancer

Kyle A. Richards, MD


January 30, 2023

In 2019, the US Food and Drug Administration approved erdafitinib, a tyrosine kinase inhibitor, for metastatic bladder cancer in patients with susceptible FGFR2 or FGFR3 alterations refractory to platinum-based chemotherapy. Studies have demonstrated a 40% response rate that was not affected by the presence of visceral metastasis. Upon longer follow-up, treatment with erdafitinib demonstrated consistent activity and a manageable safety profile in patients with locally advanced or metastatic bladder cancer and prespecified FGFR alterations.

Vascular endothelial growth factor pathway inhibitors do not have an established role in the treatment of metastatic bladder cancer. Although, in clinical trials, ramucirumab and bevacizumab demonstrated improvement in progression-free survival; no improvement in overall survival was noted. A retrospective analysis of the RANGE study showed the utility of multiple biomarkers in identifying patients with metastatic bladder cancer who might derive the greatest benefit from ramucirumab, including PD-L1, molecular subtype, and immune phenotype. Optimal sequencing and potential combinations of available agents are the subject of many ongoing trials.

Learn more about metastatic bladder cancer management.

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