ASCO 2018: Role of Surgery in Management of High-Risk Renal Cell Cancer

Chicago, IL (UroToday.com) In this two part educational session, Drs. Rini and Kim discuss the role of peri-operative systemic therapy for localized renal cell carcinoma. Dr. Kim discussed the role of surgery in the management of high-risk localized RCC.
Some of the data he touched upon overlapped with Dr. Rini’s talk, so it will not be repeated here. I highlight some of the important points he makes from his talk specifically.

ASCO 2018: Systemic Therapy in Management of High-Risk Renal Cancer

Chicago, IL (UroToday.com) In this two part educational session, Drs. Rini and Kim discuss the role of peri-operative systemic therapy for localized renal cell carcinoma. Dr. Rini discussed the current evidence and his take from a medical oncology perspective.
He first briefly discussed the experience with neoadjuvant systemic therapy, which is less established. While there were numerous retrospective studies, he focused on a few prospective studies. Two fot eh studies were done at his institution, Cleveland Clinic. All these studies assessed slightly different populations, so can’t be compared head-to-head.

ASCO 2018: Multicenter Randomized Phase 2 Trial of Paclitaxel, Ifosfamide, and Cisplatin Versus Bleomycin, Etoposide, and Cisplatin for First-line Treatment of Patients with Intermediate- or Poor-risk Germ Cell Tumors

Chicago, IL (UroToday.com) Approximately 50% of poor risk and 75% of intermediate risk germ cell tumor (GCT) patients are cured with 1st line bleomycin, etoposide, and cisplatin (BEP). Paclitaxel, Ifosfamide, and cisplatin (TIP) is a standard regimen for GCT patients requiring salvage chemotherapy with 70% complete response (CR) rate, 63% progression free survival (PFS) among relapsed GCT patients. A multicenter single arm phase 2 study published in the Journal of clinical oncology in 2016 demonstrated that TIP as first line therapy in poor- and intermediate-risk GCT patients, had a better response when compared to the historic standard of care of BEP, for poor- and intermediate- risk GCTs.[1] In this study TIP had an acceptable safety profile. The authors therefore, performed this randomized phase 2 study of TIP vs. BEP conducted across 7 centers.

ASCO 2018: The GENTleMEN Study: Genetic Testing for Men with Metastatic Prostate Cancer in Washington State and Beyond

Chicago, IL (UroToday.com) It is known that 10% of metastatic prostate cancer patients harbor germline DNA repair gene mutations.[1] These mutations (e.g. BRCA2, BRCA1) may have important implications for treatment, clinical trial selection, and family members counseling.  According to the NCCN guidelines from 2018 for prostate cancer, there is a clear recommendation for germline testing for all men with metastatic and high/very high risk clinically localized prostate cancer.[2] Despite the importance of this testing, significant limitations exist which include lack of awareness by the patient/physician, limited access to genetics services, variable insurance coverage, and associated high out-of-pocket costs.

ASCO 2018: Comparing the Occurrence of Major Adverse Cardiovascular Events (MACEs) in Patients with Prostate Cancer and Cardiovascular Disease Receiving Degarelix or Leuprolide

Chicago, IL (UroToday.com) Incidence of cardiovascular disease (CVD) and prostate cancer (PC) increase with age, resulting in higher mortality as well. CVD is the second most common cause of death in men with PC.[1,2] Gonadotropin releasing hormone (GnRH) agonists for treatment of PC have been linked to increases in CVD morbidity and mortality. This is especially evident in the first year of treatment [3], and men with a history of CVD are at greater risk [3].

ASCO 2018: Subsequent Treatment after Abiraterone Acetate + Prednisone in Patients with Newly Diagnosed High-Risk Metastatic Castration-naïve Prostate Cancer: LATITUDE

Chicago, IL (UroToday.com) Patients with newly diagnosed high-risk metastatic hormone-naïve prostate cancer quickly progress to castration-resistant disease when using androgen deprivation therapy (ADT) alone. However, over the last 12 months, we have seen two large trials [1,2] advocating for abiraterone acetate (AA) + prednisone be added to ADT (ADT + AA + prednisone) for the treatment of patients with high-risk metastatic castration-naïve prostate cancer. At ASCO 2017, the initial results of the phase III LATITUDE study were presented [1].

ASCO 2018: Cabazitaxel in mCRPC: Real-life Use, Effectiveness, Safety, and Quality of Life in the FUJI Cohort

Chicago, IL (UroToday.com) Cabazitaxel is a novel tubulin-binding taxane drug with anti-tumor activity in docetaxel-resistant cancers. The seminal trial assessing cabazitaxel in mCRPC was the phase III TROPIC randomized controlled trial published in 2010 [1]. For TROPIC, 755 men with mCRPC with disease progression after docetaxel therapy were treated with 10 mg oral prednisone daily and randomized 1:1 to either 12 mg/m2 mitoxantrone IV or 25 mg/m2 cabazitaxel IV every three weeks.