Vadim S. Koshkin, MD, and Tanya Jindal, BS, BA, on Urothelial Carcinoma: Biomarkers of Response to Enfortumab Vedotin-ejfv
2023 ASCO Genitourinary Cancers Symposium
Vadim S. Koshkin, MD, and Tanya Jindal, BS, BA, both of the University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, discuss results from the retrospective UNITE study of biomarkers of response to the antibody-drug conjugate enfortumab vedotin-ejfv in patients with advanced urothelial carcinoma. Enfortumab vedotin is used widely in treatment-refractory disease, but there have been limited data available on biomarkers that may predict outcomes with this treatment. The UNITE study has now identified several potential biomarkers that need to be validated to help inform clinical decision-making and therapy sequencing. (Abstract 450).
Disclaimer: This video transcript has not been proofread or edited and may contain errors.
Hello, everyone. I'm here today with Tanya Jindal and we're going to discuss the biomarker analysis of the UNITE Study. Tanya, tell us a little bit about the UNITE study and what it is.
Of course. UNITE is a large multi-institutional retrospective cohort of patients with advanced urothelial carcinoma treated with novel targeted agents such as enfortumab vedotin and sacituzumab govitecan. We have data from about 16 US sites for about 600 patients, and then initial data looking at patients in real-world setting was published in 2021.
That's great. Tell us about this specific analysis of the UNITE study that you're presenting at this conference.
Of course. In this analysis we'll be focusing on enfortumab vedotin. Enfortumab vedotin was approved in 2019 for treatment refractory advanced urothelial carcinoma. However, we have limited data available on biomarkers predicting outcomes of enfortumab vedotin treatment, so in this analysis, this is what we looked at.
Great. Tell us what were some of the results? What were some of the most important and pertinent findings?
Of course. We identified 170 patients with advanced urothelial carcinoma treated with enfortumab vedotin and who had next generation sequencing results available. Their demographic and baseline characteristics were pretty representative of the patient population that we see in clinic. The survival and treatment outcomes that we saw for the overall cohort, observed a response rate of 47%, median progression-free survival of 6 months, median overall survival of 12 months. These were pretty consistent with what we see in the EV clinical trials that are being done.
Yeah. What specifically were the biomarker findings?
If you focus on the biomarker findings, the observed response rate was higher in patients with alterations in ERBB2 relative to wild-type patients and TSE-1 relative to wild-type patients. However, this didn't translate into significant differences in progression-free survival and overall survival.
However, we did find several biomarkers that were associated with the time to event endpoints. Specifically, we saw a shorter progression-free survival in patients with CDKN2A, CDKN2B, and MTAP alterations, and a longer overall survival was seen in patients with high tumor mutation burden relative to patients with low tumor mutation burden.
Yeah, that's really, really interesting data. And then, of course, a very, very interesting analysis. But what were some of the limitations of this analysis?
Some of the limitations of this analysis were its retrospective design, patient selection, and associated confounding biases. Also, we used a lot of next-generation sequencing platforms, so that is something we want to work on in the future.
Despite these limitations that many retrospective studies have, of course, what are some of the, perhaps, clinical implications, the important implications for patients, and maybe some of the next steps forward as some of the future analyses we may do?
Our findings are hypothesis generating, but they require external validation. We think, in the future, it may help inform some mechanistic work, translational work, clinical trial design, and may even help select patients for treatment with enfortumab vedotin and other therapies in clinic.
Well, that's really fascinating. Thank you again for sharing these data with us, and yeah, really appreciate you being here today.
Thomas Powles, MD, PhD, of Barts Health NHS Trust, Queen Mary University of London, discusses new data from the COSMIC-313 study of patients with advanced renal cell carcinoma of IMDC (International Metastatic RCC Database Consortium) intermediate or poor risk. Those who received cabozantinib instead of placebo with nivolumab and ipilimumab as first-line treatment seemed to experience improved progression-free survival. A subgroup analysis suggested the benefit was primarily in patients with an intermediate risk. Follow-up for overall survival is ongoing. (Abstract 605).
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Matt D. Galsky, MD, of the Icahn School of Medicine at Mount Sinai and Tisch Cancer Institute, discusses final overall survival data from the phase III IMvigor130 study, which compared atezolizumab versus placebo, both of which were paired with platinum and gemcitabine in the first-line treatment of patients with locally advanced or metastatic urothelial carcinoma. (Abstract LBA440).
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