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Dr. Petros Grivas discusses what precautions should be considered when treating patients with advanced urothelial carcinoma who have diabetes.
Among patients with advanced urothelial carcinoma who present with diabetes mellitus, the efficacy of immunotherapy and other cancer-related therapies have been shown to be diminished, according to Dr. Petros Grivas, who added that this makes close monitorization and multidisciplinary care vital for these individuals.
Overall survival: the amount of time a person lives after being diagnosed with a disease, such as cancer.
Progression-free survival: a measure used in clinical trials to evaluate the effectiveness of cancer treatments.
Hyperglycemia: a condition in which blood glucose (sugar) levels are abnormally high.
Endocrinologist: a medical specialist who diagnoses and treats disorders of the endocrine system.
In an interview with CURE®, Grivas sat down to discuss what precautions should be considered when treating patients with urothelial carcinoma who have diabetes, given that it is a common comorbidity. Grivas is the clinical director of the Genitourinary Cancers Program and a professor in the Clinical Research Division at Fred Hutch Cancer Center, in Seattle; he also serves as a professor in the Division of Hematology and Oncology, at the University of Washington School of Medicine.
I think, like other medical comorbidities, we must take that into account when we treat patients. I always recommend very close follow up with primary care providers and endocrinologist to optimize the treatment of diabetes mellitus. That, by itself, represents a significant risk in those patients for cardiovascular disease and cardiovascular complications. This has become even more relevant.
Now, we use a lot of Padcev (enfortumab vedotin-ejfv) plus Keytruda (pembrolizumab) based on the phase 3 EV-302/KEYNOTE-A39 trial which demonstrated significant overall survival and progression-free survival benefit with Padcev and Keytruda versus chemotherapy; it is the preferred standard-of-care now. However, Padcev can cause hyperglycemia in about 10%, or one out of 10 patients. That makes it relevant to this discussion.
We want these patients with diabetes — both controlled and uncontrolled — to be followed closely with primary care providers and endocrinologist to optimize the control of blood sugar. We must keep very close attention in those patients regardless, and of course, while treating them with Padcev to keep track of the blood sugar. Again, we want to offer the best therapy, of course, to our patients with diabetes mellitus. However, we need to pay extra attention to the blood sugar and keep a very close follow up. We must have a multidisciplinary approach in collaboration with primary care providers and endocrinologist for optimal control of diabetes mellitus, regardless of therapies.
Transcript has been edited for clarity and conciseness.
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