Reshaping the Landscape of Bladder Cancer Treatment

In the landscape of cancer treatment, stories of dedication and breakthroughs often intertwine, offering hope amid the challenges faced by patients. In this special issue of CURE, we examine the impressive potential of antibody-drug conjugates (ADCs) in the treatment of bladder cancer, a class of drugs showing greater activity that we have seen with prior chemotherapy agents.

Antibody-drug conjugates, described by Dr. Yousef Zakharia of the University of Iowa as “targeted chemotherapy,” are designed to deliver a payload of chemotherapy directly to cancer cells, thereby intended to spare healthy cells from the impact of toxic treatments.

Patient Stacey Reeves’ journey began with the discovery of bladder cancer three years ago, leading to a series of treatments including surgery, chemotherapy and immunotherapy. Despite these efforts, she experienced multiple recurrences, but has had no evidence of disease for more than a year since starting treatment with Padcev (enfortumab vedotin-ejfv), an ADC that is reshaping the landscape of bladder cancer treatment.

Padcev’s transformative impact was high- lighted by the remarkable results of the EV-302 clinical trial, which revealed significantly improved outcomes compared to traditional chemotherapy, a near doubling of the median time to tumor progression.

The approval of Padcev and Keytruda (pembrolizumab) combination therapy by the Food and Drug Administration in December 2023 for patients with locally advanced or metastatic bladder cancer represents a pivotal event, one described as a “eureka moment” by Dr. Bamidele Adesunloye, medical oncologist at City of Hope Atlanta.

Yet, as Zakharia aptly notes, the quest for a cure remains ongoing. While ADCs represent a significant stride forward, they are not without their challenges. Unmet needs persist, reminding us of the imperative to continue the pursuit of innovation and progress in cancer care.

“Certainly, we are heading [in] that direction,” he said, “but we are far away from curing everybody.” Further innovations in the more precise delivery of increasingly more potent drugs directly to tumor cells while protecting normal cells and tissue are expected over time.

Debu Tripathy, M.D.

Editor-in-chief

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