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HIGHLIGHTS FROM THE 2023 EUROPEAN SOCIETY FOR MEDICAL ONCOLOGY ANNUAL MEETING
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| Management of High-Risk Localised PCA: How Hard Should You Look, How Long Should We Treat? |
| Usefulness and Limitations of PSMA Imaging/PET in High-Risk Localized Disease
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| Karolien Goffin, MD, Ph.D.
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| Karolien Goffin discusses the usefulness and limitations of PSMA imaging/PET in high-risk localized prostate cancer. PSMA PET/CT offers higher accuracy and improved management impact compared to conventional imaging, with increased sensitivity, specificity, and a lower radiation dose. However, false-positive bone lesions may occur in certain areas, and while PSMA PET/CT is generally well-received by patients, the cost-effectiveness may vary across healthcare systems.
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| Dose Intensification and Field Expansion of External Beam Radiation Therapy
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| Alberto Bossi, MD
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| Alberto Bossi discusses the dose intensification and field expansion of External Beam Radiation Therapy (EBRT) for high-risk localized prostate cancer. He highlights findings from the FLAME trial, which demonstrated superior biochemical disease-free survival with an additional focal boost to the MRI-visible lesion. These findings suggest that dose intensification and field expansion can be effective in the management of high-risk prostate cancer, though further research is needed to guide treatment changes based on imaging findings.
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| Delineating Staging Pelvic Lymph Node Dissection Before Radiotherapy and Positioning Primary Prostatectomy
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| Derya Tilki, MD
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| Derya Tilki delivers a presentation addressing the management of high-risk localized prostate cancer. The talk covers the intricate considerations surrounding primary treatments for this condition, including primary radical prostatectomy and the role of radiotherapy in patient outcomes. Additionally, Dr. Tilki discusses the potential benefits and challenges of performing staging pelvic lymph node dissection before radiotherapy, emphasizing the need for accurate staging in guiding therapy choices.
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| How Much Systemic Treatment Is Needed and How Long?
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| Gwenaëlle Gravis, MD
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| Gwenaëlle Gravis discusses the management of high and very high-risk localized prostate cancer, specifically focusing on how much and how long systemic treatment should be given. She emphasizes the lack of phase 3 data supporting neoadjuvant treatment with radical prostatectomy and discusses the use of adjuvant and neoadjuvant treatments with various agents, including androgen deprivation therapy (ADT), radiotherapy, and docetaxel.
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| Novel Targets, Therapies and Toxicities in Genitourinary Cancers |
| Screening New Agents in “Window of Opportunity” Neoadjuvant Trials
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| Andrea Necchi, MD
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| Andrea Necchi presents findings on the screening of new agents in the "window of opportunity" neoadjuvant trials for bladder cancer. He emphasized that neoadjuvant trials offer a unique opportunity for expedited drug approvals in oncology, potentially providing significant survival benefits in a curable context. Dr. Necchi also highlighted the importance of addressing safety concerns, ensuring physician and patient education, and establishing consensus on what constitutes a cure and curative intent in the evolving landscape of muscle-invasive bladder cancer treatment.
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| Antibody Drug Conjugates and FGFR-Directed Therapies: New Toxicities |
| Yohann Loriot, MD, Ph.D.
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| Yohann Loriot discusses new toxicities associated with antibody-drug conjugates and FGFR-directed therapies. Antibody-drug conjugates, which are effective in urothelial carcinoma, exert their antitumor effects by delivering a cytotoxic payload and the antibody's inhibitory and immune-enhancing properties, which can lead to both efficacy and toxicity.
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| Prediction of Toxicity in Current Systemic Treatment of Genitourinary Cancers
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| Sasha Gusev, Ph.D.
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| Sasha Gusev presents findings on predicting toxicity in current systemic treatments for genitourinary cancers. Notably, immunotherapy-related toxicities are still common, with 20-80% of patients experiencing grade 3+ immune-related adverse events, leading to treatment discontinuation in 10-40% of cases. Dr. Gusev's research focused on germline variants' impact on these toxicities, revealing that both polygenic risks and individual variants contribute to immune-related adverse events. |
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| Advances in the Molecular Understanding of GU Cancers: The Next Generation of Therapeutic Targets
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| Samra Turajlic, MD
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| Samra Turajlic presented insights into the molecular understanding of genitourinary cancers at the 2023 ESMO annual meeting. The molecular landscape of renal cell carcinoma (RCC) has identified crucial genes, including VHL inactivation, PBRM1 loss, SETD2 loss, and BAP1 loss. While multiple therapies have been approved for RCC, patient selection based on molecular profiling is not common, and there are no biomarkers for therapy selection.
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