Erdafitinib in Urothelial Carcinoma
N ENGL J
PUBLISHED: 17 FEBRUARY 2019
Erdafitinib received accelerated approval by the Food and Drug Administration (FDA) in April 2019 for the treatment of patients with advanced urothelial cancer who carried the FGFR2/3 alterations.
However, it remains unclear what is the most appropriate sequencing of therapies (immunotherapy and targeted therapy). Loriot et al. (July 25 issue)
suggest the use of erdafitinib over immunotherapy given the better response rate, similar rates of overall survival, and lower activity of immunotherapy in patients with the FGFR mutation. However, we have a few concerns and think that immunotherapy may still be preferred over erdafitinib. First, FGFR mutation status has yet to be proven to be a biomarker for resistance to immunotherapy. Recently, a large retrospective study of immunotherapy (which included the IMVigor 210 [A Study of Atezolizumab in Participants with Locally Advanced or Metastatic Urothelial Bladder Cancer] and CheckMate 275 [Nivolumab in Metastatic Urothelial Carcinoma after Platinum Therapy] cohorts) showed similar response rates irrespective of FGFR mutation status.
Second, a longer median response (68% of patients with a response for at least 12 months) with fewer toxic effects of grade 3 or more (15% vs. 46%) suggests that immunotherapy may provide a better safety and efficacy profile than FGFR targeted therapy.
The different immunotherapy agents have shown promising activity in advanced urothelial cancer across multiple trials.