ASCO GU 2019: A Phase II Study CALYPSO: The Safety and Efficacy of Savolitinib and Durvalumab in Metastatic Papillary Renal Cancer
San Francisco, CA (UroToday.com) The most common non-clear cell renal cell carcinoma is papillary renal cell carcinoma (pRCC). pRCC accounts for 15-20% of RCC and are subcategorized into Type 1 and Type 2. Type 1 pRCC are typically associated with MET alterations whereas Type 2 pRCC typically are found to have alterations in SETD2, TFE3, and CDKN2A1.
ASCO GU 2019: Outcomes of Patients with Metastatic Clear Cell RCC Treated with Second Line VEGFR-TKI After First Line Immune Checkpoint Inhibitor
San Francisco, CA (UroToday.com) Since the publication of CheckMate 214, immune checkpoint inhibitors (ICIs) have entered the first line space for the treatment of metastatic RCC1. However, the majority of patients do not have an objective response to ICI and will have either primary or secondary resistance. Standard of care second line therapies involves VEGFR-TKIs, but little is known about their efficacy after ICI treatment. This study seeks to address this knowledge gap by providing a multicenter experience of treatment of mRCC after ICI therapy.
ASCO GU 2019: Pembrolizumab in Men With Heavily Treated Metastatic Castration-Resistant Prostate Cancer
San Francisco, CA (UroToday.com) Immune checkpoint inhibition for prostate cancer has been met with significant challenges in the immunotherapy era. Unlike the dramatic and responses seen in melanoma, lung, kidney, and bladder cancer, prostate cancer has not had the same success in unselected patients. Even in patients with MSI high (microsatellite instability) disease, 7/11 patients did not have an objective response and 5/6 did not have a PSA50 (decline in PSA by 50%)1. This study evaluates the off-label use of pembrolizumab in a heavily pre-treated population of patients with mCRPC.
ASCO GU 2019: Questions and Lessons Moving Forward from CARMENA: Which Treatment First? Surgeon’s Perspective
San Francisco, CA (UroToday.com) Dr. Russo gave the surgeon’s perspective of cytoreductive nephrectomy. The role and rationale for cytoreductive nephrectomy (CN) is multi-fold:
- Remove a large, potentially immunosuppressive tumor that is a potential source of metastases and paraneoplastic syndromes
- Palliate local symptoms of pain or bleeding that could complicate/interrupt systemic therapy
- Obtain accurate pathologic subtyping to guide therapy
- Should never be done to induce spontaneous metastatic tumor regression (it is a real event, but rare)
ASCO GU 2019: Questions and Lessons Moving Forward from CARMENA: Which Treatment First? Medical Oncologist’s Perspective
San Francisco, CA (UroToday.com) Dr. Harshman gave the Medical Oncologist perspective of cytoreductive nephrectomy (CN) . As has been the case for many of these debates recently, there wasn’t much of a debate – both medical oncologists and urologists have been on the same page!
ASCO GU 2019: Informing the Decision Using Data Science
San Francisco, CA (UroToday.com) In this first talk of the point-counterpoint session, Dr. Psutka reviews the literature informing the decision to expand the use of partial nephrectomy to larger, more complex masses, effectively titled “extended partial nephrectomy” (ePN).
To begin, the only Level 1 evidence supporting the oncologic efficacy PN compared to RN is the EORTC study by van Poppel et al. (EU 2007). However, it was underpowered and had significant cross-over.
ASCO GU 2019: Quality Metrics in Kidney Cancer Care
San Francisco, CA (UroToday.com) The last session of GU ASCO 2019, How Can We Better Treat Kidney Cancer, started with Dr. John Gore presented quality metrics in kidney cancer care. Dr. Gore notes that quality measurement entails several processes, including effectiveness, efficacy, equity, patient-centeredness, safety, and timeliness. Dr. Gore then mentioned that health care value is disparate in the United States, considering that the country has the highest per-capita spending per person for health care ($9,892), but is 27th in life expectancy (78.8 years). By comparison, Japan is 15th in spending ($4,519) and 1st in life expectancy (83.9 years).