FOIU 2018: Current Experience in Immunotherapy for Metastatic Renal Cell Carcinoma
Tel-Aviv, Israel (UroToday.com) Axel Bex, MD gave an overview of immunotherapy in metastatic renal cell carcinoma (MRCC). Immune checkpoint inhibitors (ICI) have changed the RCC treatment landscape. Checkmate 025 trial which compared Nivolumab vs. Everolimus in 2nd line MRCC demonstrated an improved median overall survival (OS) for nivolumab of 25 vs. 19.6 months, p=0.002.
FOIU 2018: Immune-Oncology In Genitourinary Malignancies - Have We All Been Too Enthusiastic Too Soon?
Tel Aviv, Israel (UroToday.com) Raya Leibowitz-Amit, MD, PhD, gave an interesting talk on the role of immunotherapy in genitourinary malignancies. The first immunotherapy trial in locally advanced or metastatic urothelial cancer, KEYNOTE 012, was presented in ESMO 2014 in Madrid and analyzed the activity of pembrolizumab. This was a non-randomized, multi-cohort, open-label, phase 1b basket trial. Only patients with ECOG 0/1 and PD-L1 staining of at least 1% in tumor or stroma cells could have been enrolled in this trial. Of the 115 pre-screened patients, 61 were PD-L1 positive, of whom 33 were enrolled, and only 27 were assessable. After a median follow-up of 13 months, 7/27 patients achieved an overall response. The response rate was 26% with a median response duration of 10 months.
FOIU 2018: Current Experience in Immunotherapy for Metastatic Bladder Cancer
Tel-Aviv, Israel (UroToday.com) Avishay Sella, MD gave a talk about the evolution of immunotherapy in bladder cancer. The immunologic systemic therapy for urothelial cancer has significantly progressed in recent years. Currently, there are 5 FDA approved medications for use in bladder cancer. These include:
FOIU 2018: Immunotherapy as an Early Treatment? What Have We Learned From Other Malignancies?
Tel Aviv, Israel (UroToday.com) Daniel Goldstein, MD, gave a talk on the possibility of immunotherapy given as at an earlier stage. The role of immunotherapy in the adjuvant/neoadjuvant setting is still being explored and studied. The utility of immunotherapy in metastatic urologic cancers is still being analyzed. There are distinct phases of treatment effect in immunotherapy, as can be seen in Figure 1.
FOIU 2018: Adjuvant Therapy for Locally Advanced and Node-positive Upper Tract UC
Tel-Aviv, Israel (UroToday.com) Marc Wygoda, MD, gave a talk on the role of adjuvant therapy for locally advanced upper tract urothelial carcinoma (UTUC). UTUC is a rare tumor, accounting for 5% of all urothelial carcinomas. The common and standard treatment is radical nephroureterectomy (RNU). Approximately 60% of these tumors are muscle invasive with a high rate of recurrence and metastatic disease. These result in poorer survival, stage for stage, when compared to bladder cancer.
FOIU 2018: Urothelial Carcinoma of the Upper Tract Following Radical Cystectomy
Tel-Aviv, Israel (UroToday.com) Seth Lerner, MD, gave an overview of urothelial carcinoma of the upper tract (UTUC) occurring following radical cystectomy (RC). He began his talk mentioning a systematic review including 57 studies1, demonstrating an incidence of UTUC following RC of 4-10%. The variables associated with UTUC after RC include:
- Bladder carcinoma in situ (CIS)
- History of non-muscle invasive bladder cancer (NMIBC)
- CIS in the distal ureter
FOIU 2018: Is There a Risk in Robotic Nephro-ureterctomy?
Tel-Aviv, Israel (UroToday.com) Dr. Shalhav gave an excellent talk on the different surgical modalities of radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). He began by discussing some papers comparing open and laparoscopic RNU, that have been published in recent years. The first paper discussed compared 40 laparoscopic to 40 open RNU, demonstrating that only subgroups of Pt3 UTUC and high-grade tumors have better cancer specific survival (CSS) and metastasis free survival (MFS) in open RNU (ORNU) compared to laparoscopic RNU (LRNU).