Patient-Provider Conversations After a Bladder Cancer Diagnosis

With the addition of new therapies — such as Padcev (enfortumab vetoditn) plus Keytruda (pembrolizumab) — for locally advanced bladder cancer, there are a few conversations that patients might have with their clinicians shortly after being diagnosed, explained Dr. Laura Bukavina, a urologic oncologist from University Hospitals.

Patients with lymph node-positive disease traditionally have not been candidates for surgical resection, though that is changing now, so patients might discuss the potential role of surgery with their care team. Additionally, patients might discuss how long they should be on therapy, and when is the appropriate time to stop treatment or switch to a maintenance regimen, according to Bukavina, who sat down for an interview at the 2024 Genitourinary Cancers Symposium.

Transcript

So the first things within the urologic oncology world, I think the conversations that we're going to have is (for) patients with lymph node-positive disease at the time of presentation (is along the lines of), “So you’re one of the patients who typically in the past, we would have considered to be non-surgical candidates.” They're non-surgical (candidates) because of diseases already outside the scope of the bladder. And typically, it's chemotherapy and adjuvant therapy (for these patients).

Now, with the addition of (Padcev [enfortumab vedotin] plus Keytruda [pembrolizumab]) as well as the results, remarkable results that we're having, the questions that we're going to have to address is: what is the role of surgery in those patients, even in lymph-node positive disease? There are ongoing trials right now they're recruiting, looking specifically at those patients with pelvic lymph nodes, in addition to (Padcev plus Keytruda), in that setting, in addition to radical cystectomy. So that's one of the things.

The second question is we're going to have to talk about is the risks versus benefits of therapy. And also, how long do we continue the therapy? Currently, we know that it works great, but what is our time point in terms of discontinuation of many of these agents? If we there's certainly data for two, three years, but at what point do we say, you know, perhaps we need to stop and think of those patients are cured? Do they need to be just on surveillance, or do we need to come up with a maintenance therapy that's less toxic for them?

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