Bladder KOL US膀胱癌-美国访谈
AI智能总结KOL Insight on Bladder Cancer
Patient Demographics and Treatment Patterns
- Patient Proportions: At any given time, 20% of bladder cancer patients under the care of the physician have muscle invasive disease and are undergoing neoadjuvant therapy, while the remaining 80% have metastatic disease.
- Cystectomy: Among patients referred for neoadjuvant or muscle invasive disease, 95% undergo cystectomy. However, some patients who are not surgical candidates may receive radiotherapy instead.
Current Treatment Approaches
- BCG and Pembrolizumab: BCG remains the standard for treating non-muscle invasive disease (NMIBC), though it fails in approximately half of the cases. Pembrolizumab's use has been limited due to its parenteral requirements and underwhelming clinical experience.
- Combination Therapy: The future of combination therapy is largely dependent on the registration trial of enfortumab and pembrolizumab. The combination of everolimus and paclitaxel (EVP) shows the most promising data. Chemotherapy combined with an immune checkpoint inhibitor is not considered a viable first-line treatment.
- Maintenance Therapy: For patients achieving stable disease or better after platinum-based therapy, Bavencio (avelumab) is used as maintenance therapy.
Future Directions
- Enfortumab and Pembrolizumab: If approved, this combination is expected to have rapid uptake due to its initial approval for non-cis-eligible patients, potentially leading to broader use.
- Non-Cis-Eligible Patients: The combination therapy is likely to be used more widely once approved, driven by its initial approval and subsequent "mission creep."
Unmet Needs
- BCG-Unresponsive Disease: Despite BCG's effectiveness in about half of patients, there remains a significant unmet need for patients with BCG-unresponsive disease.
- Metastatic Disease: The majority of patients with metastatic disease are not cured, indicating a substantial unmet need for effective treatments.
Key Points
- Treatment Variability: The proportion of muscle invasive and metastatic disease varies significantly from week to week, making it challenging to predict exact numbers.
- Community vs. Academic Centers: Radical cystectomy and cisplatin neoadjuvant chemotherapy are more commonly performed in large academic centers and certain community hospitals due to the complexity of these procedures.
- BCG Shortage Impact: The BCG shortage has led to reduced dosages and altered maintenance programs, impacting the management of NMIBC.
This summary captures the key insights and data points discussed in the interview, highlighting the current landscape and future directions in bladder cancer treatment.
