New Biomarkers and Toxicities Expand Pharmacists’ Role in Bladder Cancer

Pharmacy Times interviewed Robin Tumlinson, PharmD, BCOP, clinical pharmacist specialist in genitourinary oncology at Vanderbilt University Medical Center, about the growing role of biomarkers in bladder cancer and the opportunities for oncology pharmacists to support treatment safety.

Tumlinson explained that biomarker testing is increasingly used in metastatic urothelial carcinoma to guide treatment following enfortumab vedotin (Padcev; Astellas Pharma) plus pembrolizumab (Keytruda; Merck). Testing for FGFR alterations can identify patients who may be eligible for erdafitinib (Balversa; Johnson & Johnson), whereas HER2 immunohistochemistry may inform the use of HER2-directed treatment. Biomarker findings may also help clinicians identify relevant clinical trials.

The interview also addresses the emerging role of circulating tumor DNA (ctDNA) in detecting molecular residual disease and informing adjuvant treatment decisions. Tumlinson discussed whether ctDNA or urinary tumor DNA could eventually help identify patients who may be eligible for treatment de-escalation, shorter adjuvant therapy, or bladder-preserving approaches. However, additional evidence is needed before these strategies can be incorporated broadly into clinical practice.

Tumlinson also noted several practical barriers to biomarker testing. Turnaround times may affect clinical decision-making, particularly when testing is not initiated early. Repeated ctDNA assessments can also create a considerable administrative burden for the nursing teams responsible for coordinating testing and monitoring results.

Additionally, Tumlinson discussed how oncology pharmacists can identify patients at increased risk for adverse events, provide education before treatment, recommend supportive care, and help manage toxicities ranging from mild diarrhea, dry eye, and rash to severe immune-related reactions. Pharmacists can also support appropriate dosing and dose reductions for agents such as enfortumab vedotin and manage treatment-specific concerns associated with erdafitinib. These interventions can help patients remain on treatment safely as bladder cancer care becomes increasingly complex.