Overview
Urothelial carcinoma (UC) is the most common histologic subtype of bladder cancer, affecting over 80,000 new cases in the US in 2025. Erdafitinib, a pan FGFR (fibroblast receptor growth factor) inhibitor, is FDA-approved for patients with LA/mUC harboring FGFR alterations with disease progression on at least 1 line (1L) of prior systemic therapy. FGFR3 genetic alterations occur in 15-20% of LA/mUC, and biomarker-directed therapy should be considered for patients with ≥ 1 prior line of treatment. Genomic testing for FGFR3 is recommended at LA/mUC diagnosis, however, real-world adherence to these recommendations and disparities in testing are poorly understood.
Researchers analyzed data from nearly 3,700 patients with advanced bladder cancer diagnosed between 2022 and 2025 and found that only 41% underwent FGFR3 genetic testing. Further, only 28% were tested before starting first-line treatment—the optimal time to identify candidates for targeted therapy. Testing rates were significantly lower for older patients, Black patients, those with lower urinary tract tumors, and those initially diagnosed with non-metastatic disease. Among the patients who were tested and found to have FGFR3 mutations, only 41% received the targeted drug erdafitinib in later treatment lines.
Why this matters
These gaps in timely genetic testing indicate that many patients are potentially missing access to personalized treatments that could improve survival. The study's findings highlight critical inequities in precision medicine delivery and underscore the urgent need for strategies to ensure all eligible patients—regardless of age, race, or disease characteristics—receive equitable access to genomic testing and targeted therapies.