‘Moving Into an Era’ of Targeted Bladder Cancer Treatments

Patients with pretreated high-risk non muscle-invasive bladder cancer that harbored a FGFR alteration tended to have improved relapse-free survival (time from treatment until disease relapse) with Balversa (erdafitinib) compared with chemotherapy, according to findings from a group of patients involved in the THOR-2 trial.

Balversa is a targeted drug that was initially approved in 2019 for the treatment of patients with locally advanced or metastatic bladder cancer that harbored a FGFR3 or FGFR2 alteration and progressed during or after platinum-based chemotherapy.

Study data, which were presented at the 2023 ESMO Congress, showed that the median relapse-free survival was not reached in the Balversa group — indicating that not enough patients experienced relapse for the researchers to determine an average — and 11.6 months for the group that received chemotherapy. Further, six-month relapse-free survival was 96% and 73%, while 12-month relapse-free survival was 77% and 41% in the Balversa and chemotherapy groups, respectively.

While these findings may be exciting for this patient population, all of whom were previously treated with bacillus Calmette-guérin (BCG) therapy, patients without a targetable mutation — so in this case, FGFR — may not be able to experience the benefit of certain new therapies that are being studied for bladder cancer, explained Dr. James Catto, professor of Urological Surgery at the University of Sheffield, who presented the THOR-2 data.


The way we treat the disease can be general or targeted. Most patients now get chemotherapy, which is not specifically targeted to any particular cancer, just across the whole board. It works very well for some cancers, but it doesn’t work very well for other cancers. We’re moving into an era where we’re doing that far more targeted treatments. (Balversa [erdafitinib]) is a drug that works on a particular mutation in a cancer pathway. If your cancer has that mutation, and about a third of them do, and it works very well. If you don’t have it, then it doesn’t work.

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