Disparities in Access to Novel Systemic Therapies in Patients With Urinary Tract Cancer: Propagating Access, Policies and Resources Uniformly

Clin Genitourin Cancer. 2023 Apr;21(2):301-308. doi: 10.1016/j.clgc.2022.10.002. Epub 2022 Oct 13.

Abstract

After several decades of therapeutic stagnation, the treatment of patients with urothelial carcinoma has met a revolutionary wave, anticipated by the advent of immune-checkpoint inhibitors (ICI) and followed by newer therapeutic options in the post-ICI setting. These achievements were made in a very short time-frame, thus making the treatment of this disease particularly susceptible to geographical health disparity due to the differences in healthcare systems and approval processes of the regulatory authorities. Furthermore, additional barriers to access innovative care are represented by a limited coverage of clinical trials availability, that is consistent in focusing on selected geographical areas, across trials and clinical settings. Here, we present the current picture of new drug approvals in urothelial carcinoma worldwide, and we also focus our considerations onto the spectrum of ongoing trial inclusion possibilities, trying to understand what are the current gaps in clinical research and routine practice, identifying a way to move forward.

Keywords: Antibody-drug conjugates; Bladder cancer; Geographical disparity; Immunotherapy; Targeted therapy.

MeSH terms

  • Carcinoma, Transitional Cell* / drug therapy
  • Humans
  • Immunotherapy
  • Policy
  • Urinary Bladder Neoplasms* / pathology
  • Urologic Neoplasms* / drug therapy