Don't forget to complete the post-survey &
🏆 Claim #CME 👉bit.ly/muc_tw2_post

23/🔑SUMMARY🔑

2L & later line tx in mUC
👉Erdafitinib FDA-approved w/ FGFR3 alt after prior tx
🎉NCCN guidelines updated Jan 2025
🔬Ongoing trials for SG in diff clin scenarios
✔️T-DXd for HER2 IHC3+ (based on gastric cancer scoring algorithm)

21/Why TROPiCS4 neg for OS?
Hard to est, consider:
🔸Late-line,hvly pretx pop
🔸Ltd primary G-CSF prophy in SG arm(~20%)
🔸~5% pts randomized to control never rec’d tx(~2% in SG arm)
🚫biomarker selection(UGT1A1 gene polym→⬆️tox?)
🔸~20% in each arm rec'd salvage EV(confounding)

20/ @Uromigos thoroughly addressed of sacitizumab govitecan TROPiCS-04 findings presented at #ESMOAsia
🎧Worth a listen 👉 bit.ly/UromigosEp371
#OncSky

19/TROPiCS-04
Ph3 RCT SG vs chemo in pretx mUC
🚫sig. improvmt in OS w/ SG compared to taxane or VIN

mOS: SG 10.3 vs chemo 9.0mo
(HR:0.86; 95% CI:0.73–1.02; p=0.087)
Grade ≥3️ TRAEs (SG): Neutropenia(35%; FN 12%), diarrhea (15%)
G5 AEs: SG 7% (16 inf w neutropenia), chemo 2%

18/🔬TROPHY-U-01 Cohort 3 trial safety of sacituzumab govitecan👇

TRAEs led to➡️
✋SG interruptions in 46%
⬇️SG dose reduction in 39%
🛑SG d/c in 15%
@markuseckstein3.bsky.social @amandanizammd.bsky.social #OncSky

17/#TROPHYU01 Cohorts 1,2,3👇
1️⃣=113 pts who progrs'd after plat chemo+ICI
✅Notable efficacy compared to hist cntls
Led to accel approval 2021

2️⃣=38 cisplatin-inelig pts s/p ICI tx
✅ORR=32%

3️⃣= 41 pts who progrs'd after plat chemo w 2L SG+pembro
✅ORR=41%
mPFS=5.3m
mOS=12.7m

16/Sacituzumab govitecan(SG) an ADC 🎯Trop-2
An active agent in mUC but failed to show stat. significant longer OS over taxane or vinflunine (VIN) in TROPiCS-04

✅FDA approval w/drawn~Oct 2024
👉Let’s look @ original approval & possible reasons for a negative P3 trial

15/🏁What about T-DXd in mUC?
1st tumor agnostic ADC w FDA approval for Tx-refractory HER2+ IHC3+ Cas

From DESTINY-PanTumor02
16 pts w/ HER2 IHC3+ mUC
56.3% ORR, mPFS 7.4mo, mOS 13.4mo
No significant neuropathy
🔑AEs: pneumonitis, neutropenia, N/V, left ventricular dysfunction

14/💡For phosphate of 8.0 mg/dL, withhold erdafitinib & restart once phosphate <5.5 mg/dL

🙌Erdafitinib=good option for pts w susceptible FGFR3 alt

⚖️What about pts who progress after 1L tx & no FGFR3 alt?
⚖️How does the changing 1L tx landscape w EV+P affect choice of 2L tx?

11/Erda. Safety
Grade ≥3 TRAEs occurred in 45.9% w erdafitinib & 46.4% w chemo

⚖️Most AEs w erdafitinib manageable w dose modification & best supportive care
🛑Tx d/c rates 8.1% w erdafitinib & 13.4% w chemo
#OncSky #BladderCancer

10/➡️Erdafitinib cont.
👍mOS and mPFS significantly ⬆️in erdafitinib group vs taxane or vinflunine

THOR1 trial efficacy results 👇
#OncSky @achoud72.bsky.social @pbarata95.bsky.social @crisbergerot.bsky.social @paulobergerot.bsky.social @alisonbirtle.bsky.social @laurabukavinamd.bsky.social

8/Even w pembro➡️24 mo PFS rate in KEYNOTE-045 was 12.4%👉Pts likely to need subsequent line tx

🧐NCCN guidelines RE: next tx?
Options (if not given prior):
🔶EV
🔶Erda for FGFR3 alt
🔶T-DXd for HER2 IHC 3+ (gastric Ca scoring)
🔶Saci(indication withdrawn, still in NCCN gdlns)

7/ IMvigor130 safety results 👇

🎯 Fewer AEs ➡️ withdrawal of any agent in atezo only group
🎯 Most common TRAEs mainly related to chemo
✓ Anemia
✓ Neutropenia
✓ Thrombocytopenia
#OncSky

6/Atezolizumab EMA approved as monotx
✓1L in cisplatin-ineligible + PD-L1 +ve
Based on IMvigor 210 & 130 trials

🔬IMvigor 130:
✅mPFS significantly longer in atezo+plat/Gem vs plat/Gem alone
🚫mOS not sign. longer in atezo grps vs plat/Gem alone
@oncobellmunt.bsky.social @sandysrimd.bsky.social

5/Other 2L options(depending on prior tx):
✔️Erda for FGFR3 alterations
✔️EV monotx
Taxane if no access to☝️

✔️Nivo or avelumab if no access to pembro + ICI naïve
✔️T-DXd for HER2 3+ IHC (gastric Ca scoring)
✔️Sacituzumab govitecan (FDA indication withdrawn)
@pcvblack.bsky.social #OncSky

4/Preferred 2L tx for cisplatin-ineligible pts after 1L ICI monoTx
✅EV or ➡️gem + carbo or ➡️erdafitinib (if FGFR alt+)

👉Pembro alone is one of2L tx options for pts who progress after 1L platinum-based chemo and have not received ICI
#OncSky

3/Chemo-naive cisplatin eligible pts
👇Post-1L IO monotx👇
💡2L gem+cisplatin (or ddMVAC) pref'd
💡Erda for FGFR3 mut/fusion (THOR level 1 evidence for erda post-IO)

👉Cisplatin ineligible pts can get gem+carbo or EV (or erda if FGFR3+ alt)
#OncSky

2/ 📸👇COI & CME info👇
Full #CME ℹ️ bit.ly/muc_tw2
1️⃣ Answer Pre-survey 👉 bit.ly/muc_tw2_pre
2️⃣ Review #MedTweetorial👇
3️⃣ claim CME🏆bit.ly/muc_tw2_post

#MedTwitter #OncTwitter #gucsm #BladderCancer #MetastaticUrothelialCarcinoma #OncX #CommunityOncology

1/ Best practices for 2L+ tx #MetastaticUrothelialCarcinoma 🧵
w🌟 @tiansterzhangmd.bsky.social & me

...assuming EV+P 1L
✅FGFR3 alts: THOR/erda
🎯Trop-2: sacituzumab govitecan
🏁HER2 IHC 3+: T-DXd

Support by edu grants: Astellas, Gilead Sci, Merck, Seagen
#CME from @bonumce.bsky.social ℹ️👇

This GU oncology family — wonderful first #AUC3 consensus conference!
@drchoueiri.bsky.social @pgrivasmdphd.bsky.social @davidaggen.bsky.social

Expanded indication for TDXd!

Happy New Year from OncoAlert

@jrgralow.bsky.social
@elisabettabonzano.bsky.social
@stolaney1.bsky.social
@stoverlab.bsky.social
@pgrivasmdphd.bsky.social
@axelmerseburger.bsky.social
@drnataliagandur.bsky.social
@biagioricciutimd.bsky.social
@fernandoonco.bsky.social

Awesome panel moderated by #MontyPal #BradMcGregor for non clear cell #Kidneycancer. Histology matters! And so do molecular markers! #AUC3

@drchoueiri.bsky.social @pgrivasmdphd.bsky.social @davidaggen.bsky.social @erplimackmd.bsky.social

Redefining first-line options for advanced urothelial carcinoma! Insights on platinum chemotherapy, immunotherapy combos, and patient-tailored strategies. @tiansterzhangmd.bsky.social @oncoalert.bsky.social @oncbrothers.bsky.social
#Oncology #BladderCancer

Huge kudos to the NCCN for officially incorporating prostate cancer into the Genetic/Familial High-Risk Assessment Guidelines. We've come a long way!

This Christmas and every year I remember my current and past patients with ornaments on our tree. Have been fortunate to care for thousands in my ten year career in oncology. Hope to help thousands more in the years to come. 🎄🕯️

Launching #AUC3 in Miami, consensus across kidney and bladder cancers. From small steps to significant scientific advances that change our patients’ lives. @drchoueiri.bsky.social #MontyPal #RanaMcKay #JonathanRosenberg

#BrianShuch kicks us off, local #kidneycancer heterogeneous - guppies, goldfish and sharks! Integrating staging & biomarkers to help us evaluate risk and prognosis. #AUC3