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The indication for sacituzumab govitecan (Trodelvy) in previously treated patients with locally advanced or metastatic urothelial cancer was withdrawn last month after the drug failed to improve survival versus single-agent chemotherapy in the phase III TROPiCS-04 trial.

In light of this changed landscape, Joaquim Bellmunt, MD, PhD, of Dana-Farber Cancer Institute in Boston, discusses second-line treatment options.

Following is a transcript of his remarks:

Sequencing is now an issue because we have now, as mentioned, three options for first-line treatment and the point is what to do next. And then in patients who are receiving chemotherapy followed by maintenance avelumab [Bavencio], after that some patients are receiving enfortumab vedotin [EV, Padcev], and then after that receiving sacituzumab govitecan. That's the present sequencing on that.

In patients who are receiving EV/[pembrolizumab (Keytruda)], then obviously the most rational next step -- and without any data supporting that -- we are giving cisplatin because we have not been using the cisplatin in first-line therapy.

Before this ASCO [American Society of Clinical Oncology], another thing that has not been presented is, we heard the , that is the sacituzumab phase III. Unfortunately, this trial was negative. And this is quite concerning because now we were going to have another drug, an ADC [antibody-drug conjugate] sacituzumab govitecan, for sequencing.

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