The treatment for urothelial carcinoma is shifting toward the direction of 'short chemotherapy, long survival'.

The DISCUS study confirmed that there is no difference in treatment outcome even when platinum-based chemotherapy is administered for only three cycles. This evidence demonstrated that it can reduce unnecessary toxicity while maintaining survival.

During a meeting with DailyPharm, Professor In Ho Kim of Seoul St. Mary's Hospital's Department of Oncology assessed, "Bavencio is now a treatment strategy that goes beyond simple maintenance therapy, reducing patient burden while extending survival benefit." He added, "The DISCUS study, disclosed at ESMO (European Society for Medical Oncology) conference, clearly demonstrated the potential for patient-centric treatment."

"Switching to Bavencio after 3 cycles of chemotherapy... no survival difference, improved quality of life"

The DISCUS study was an exploratory Phase 2 trial that compared the effect of Bavencio maintenance therapy in 267 patients with locally advanced or metastatic urothelial carcinoma, divided into two groups: 3 cycles (133 patients) and 6 cycles (134 patients) of platinum-based chemotherapy.

The study results showed that the median overall survival (OS) for the 3-cycle group was 18.9 months, with no significant difference compared to the 6-cycle group (18.9 months). Progression-free survival (PFS) was also statistically similar (3-cycle group had 8.0 months vs. 6-cycles group had 9.0 months).

Notably, quality of life (QoL) improved in patients who received shorter chemotherapy. The QoL score change in the 3-cycle group was 0.0 points (95% CI -5.9 to 5.2), showing an improvement of +8.5 points (p=0.016) compared to the 6-cycle group (-8.5 points; 95% CI -14.1 to -2.9).

Regarding this, Professor Kim explained, "While it was customary in the past to administer up to six cycles, in reality, side effects and fatigue often accumulated around the fourth cycle, making treatment continuation difficult." He said, "The DISCUS study provides clinical evidence that sufficient efficacy can be achieved without compromising the patient's condition."

Professor Kim added, "In clinical practice, treatment cycles were often adjusted to around four cycles based on the patient's condition, and this result supports that empirical finding."

Professor Kim summarized the study's key finding as maintaining therapeutic efficacy while reducing the burden of side effects.

He said, "For urothelial carcinoma, the treatment process itself can cause greater suffering to the patient than the treatment types," and added, "The strategy of switching to Bavencio after short chemotherapy is a model that captures both survival and quality of life."

In the DISCUS study, the incidence of adverse events was 11.9% in the 3-cycle group and 15.7% in the 6-cycle group, confirming a lower toxicity burden in the shorter chemotherapy group.

Bavencio's clinical significance is further strengthened by the fact that its clinical trial results and Real-World Data (RWD) are nearly identical.

Professor Kim stated, "The efficacy of most drugs is lower in actual clinical practice, but Bavencio's results in the clinical trial and the real world align," and added, "It is due to low toxicity and good tolerability, which allows it to be used even in patients with poor health.

The same result was confirmed in the AVENANCE RWD analysis conducted in France.

In patients whose disease had not progressed after platinum-based chemotherapy, the probability of surviving for more than 1 year after receiving Bavencio maintenance therapy for 1 or 2 years was maintained at the same level as in the JAVELIN Bladder 100 trial.

Professor Kim said, "This data consistency is evidence that medical professionals can trust in treating patients," and added, "I often see elderly patients continuing treatment stably."

"Customized treatment completed through patient value and communication"

This effect is evaluated as significant for urothelial carcinoma, a disease where patients aged 70 and over account for the majority.

Professor Kim said, "In the past, chemotherapy was rarely given to patients in their 80s, but recently, treatment has been continued if their condition is good," and added, "What is important in such cases is not just the duration of survival but how comfortably they can receive treatment."

He continued, "Patients are increasingly expressing that they do not want difficult treatments." He stressed, "The process of shared decision-making, where medical staff and patients set treatment goals together, is now essential."

Meanwhile, the enfortumab vedotin + pembrolizumab combination therapy also garnered significant interest at this conference.

Professor Kim said, "The clinical indexes are very impressive, but the patients participating in clinical trials are generally in good overall condition," and added, "In everyday clinical practice, the proportion of patients in poor condition is higher, making it difficult to apply the data directly."

He mentioned, "If a patient's disease is progressing very rapidly, combination therapy should be considered. However, patients with more controllable metastases, such as liver or lymph node metastases, can achieve long-term survival with Bavencio maintenance therapy alone."

Professor Kim continued, "In everyday clinical practice, the patient's condition and preferences must be considered comprehensively over numerical data." He assessed, "Bavencio is the most 'balanced option' in this regard."

Professor Kim summarized the key findings confirmed at this ESMO as the 'importance of the process, not the answer'.

Professor Kim said, "Each urothelial carcinoma patient has different disease progression rates, metastasis patterns, and values. Some patients say, 'I want to live a little longer,' while others say, 'I want to maintain my routine quietly.'" He concluded, "Ultimately, the treatment strategy is finalized through conversation with the patient."

Finally, Professor Kim said, "The strategy of maintenance therapy after 3 cycles of chemotherapy, as suggested by the DISCUS study, is the starting point for this individualized treatment," and, "Bavencio is the most realistic choice that can guarantee quality of life while maintaining survival benefits."