ASCO 2018: Relapse-Free Survival of Clinical T2-4N0 Urothelial Bladder Carcinoma After Radical Cystectomy, with or without Perioperative Chemotherapy: Endpoints for Clinical Trial Design.

Chicago, IL (UroToday.com) Results from several prospective trials have led to neoadjuvant chemotherapy followed by radical cystectomy being considered the gold-standard treatment for patients with muscle-invasive bladder cancer (MIBC)1 2.
In a meta-analysis of 886 patients analyzed after neoadjuvant chemotherapy and radical cystectomy, the pathological complete response rate was 28.6%, leading to a relative risk for OS of 0.45 (95%CI 0.36-0.56) compared to those that did not achieve complete response3. However, data from 19 centers outside of a clinical trial suggested that pathologic complete response rates may lower in the real-world setting (23.9-24.5%) compared to clinical trials 4. As such, the full benefit of neoadjuvant therapy may not be captured via pathologic complete response rates.

ASCO 2018: Treatment of Metastatic Hormone-Sensitive Prostate Cancer and Implications for Subsequent Management

Chicago, IL (UroToday.com) Neeraj Agarwal provided a comprehensive overview of the treatment of metastatic hormone-sensitive prostate cancer (mHSPC). Three general topics were reviewed – the current standard of care for men with (mHSPC), the role of definitive therapy of primary prostate cancer (PC ) in the setting of mHSPC, and the implication of the upfront use of novel therapies on subsequent treatments in the setting of metastatic castrate-resistant prostate cancer (mCRPC).

ASCO 2018: Measurable Immunologic Changes and Improved Clinical Activity in mRCC with Nivolumab + Bevacizumab or Nivolumab + Ipilimumab

Chicago, IL (UroToday.com) Frontline therapy for metastatic renal cell carcinoma has changed dramatically over the past 25 years. The therapies exploit different biologic pathways which are dysregulated in RCC, including targeting vascular endothelial growth factor, fibroblast growth factor, stem-cell factor, and platelet-derived growth factor via tyrosine kinase inhibitors (TKIs) and mammalian target of rapamycin (mTOR) inhibitors1. Immunotherapy was there at the very beginning with IL-2 – however, only a small portion of patients had a durable benefit2.

ASCO 2018: Pembrolizumab plus Enzalutamide in mCRPC: Extended Follow Up

Chicago, IL (UroToday.com) While PD-1 inhibitors have made a marked impact on the survival of many patients with solid tumors, metastatic castration-resistant prostate cancer remains challenging to treat with checkpoint inhibitors and most patients are refractory to single-agent PD-1 inhibition on clinical trials. It has been reported that patients who progress on enzalutamide have increased PD-L1/2+ dendritic cells in blood compared to those patients who are responding to therapy1. Thus, it has been hypothesized that patients who progress on enzalutamide may have a primed tumor microenvironment which may sensitive them to PD-1 inhibition.

ASCO 2018: Enzalutamide Plus CC-115 in Men with mCRPC: A Phase 1b Prostate Cancer Clinical Trials Consortium Study

Chicago, IL (UroToday.com) Enzalutamide is an oral anti-androgen receptor inhibitor which improves overall survival in men with castration-resistant prostate cancer before and after exposure to chemotherapy1,2. Overall response rates range from 29% to 60% depending on the study population with a median PFS of 19.4 months in STRIVE3. However, all patients will eventually progress on therapy, many due to AR gene rearrangements causing truncated AR splice variants that lack the AR ligand-binding domain4. Thus, additional novel therapies are necessary to modulate androgen receptor signaling. 

ASCO 2018: Balancing Toxicities, and Therapeutics Perspective

Chicago, IL (UroToday.com) Celestia Higano, MD, gave an excellent talk on the topic of treatment toxicities in patients with metastatic hormone-sensitive prostate cancer (MHSPC). Dr. Higano began with the most important question in this topic, on how to decide which therapy to use in MHSPC. One of the options is to decide by volume of metastatic disease. 

ASCO 2018: Long-Term Androgen Deprivation, With or Without Radiotherapy, in Locally-Advanced Prostate Cancer: Updated Results from a Phase III Randomized Trial

Chicago, IL (UroToday.com) There is a need to know whether there is a beneficial effect for the addition of external beam radiation therapy (EBRT) to long term androgen deprivation therapy (ADT), in patients with locally advanced prostate cancer. The authors of this study presented long term results (7.3 year median follow-up) of this specific trial published in 2012.[1]