ASCO 2018: SPEAR-Bladder (Study Informing Treatment Pathway Decision in Bladder Cancer): First-Through Third-Line Time to Treatment Failure in the US

Chicago, IL ( Over the last three years, there have been exciting developments for immunotherapy for patients with advanced and metastatic urothelial carcinoma, stemming from several phase II and phase III trials [1-7]. This has resulted in FDA approval for several immunotherapy agents, including pembrolizumab, avelumab, durvalumab, atezolizumab, and nivolumab, in the second line and cisplatin ineligible first-line setting. Gurjyot K. Doshi, MD, and colleagues presented results of their analysis assessing time to treatment failure among patients with metastatic urothelial carcinoma treated with systemic chemotherapy and immunotherapy regimens in the US community oncology setting.

ASCO 2018: Sipuleucel-T OS and Clinical Outcomes by Baseline PSA Quartiles in Patients with mCRPC: PROCEED Registry

Chicago, IL ( Sipuleucel-T is an autologous cellular immunotherapy for asymptomatic/minimally symptomatic men with metastatic castration-resistant prostate cancer (mCRPC). The seminal phase III clinical trial leading to FDA approval of Sipuleucel-T was the IMPACT trial, randomizing 512 men with mCRPC in a 2:1 ratio to receive Sipuleucel-T (n=341) or placebo (n=171)1. The primary endpoint was overall survival (OS), analyzed by means of a stratified Cox regression model adjusted for baseline levels of serum PSA and lactate dehydrogenase.

ASCO 2018: Bladder Cancer and Germ Cell Tumors

Chicago, IL ( Matthew Galsky, MD gave a concise summary of the 3-oral abstracts presented in this session and he began with summarizing the two bladder cancer abstracts. Survival of patients with muscle invasive bladder cancer (MIBC) remains suboptimal, despite neoadjuvant chemotherapy and cystectomy.

Abstract 4506 was a single arm, phase II study analyzing two cycles of Atezolizumab prior to radical cystectomy among patients with T2-4N0M0 transitional cell carcinoma. The primary endpoints included pathological complete response occurring in ≥20% of patients, and increase in CD8 count. Adverse events were assessed as well. Overall, there were 74 patients receiving Atezolizumab, and 67 underwent subsequent radical cystectomy. The results demonstrated that almost 30% of the patients had pathological complete response (T0 disease), 40% were PD-L1 positive patients, and 16% were PD-L1 negative patients.

ASCO 2018: Immunotherapy in Prostate Cancer: The Path Forward

Chicago, IL ( Ravi Madan, MD gave a great overview of immunotherapy in prostate cancer (PC). Overall, there has been modest results demonstrated with PD1/PDL1 monotherapy in metastatic cancer resistant prostate cancer (mCRPC). Sipleucel-T vaccination is a PC immunologic FDA-approved treatment for mCRPC, demonstrating improved survival when compared to placebo (Figure 1).[1] However PD1/PDL1 inhibition is generally ineffective in PC. This may be since most PC patients lack sufficient immune cells in the tumor microenvironment, but this is a potentially a modifiable microenvironment.

ASCO 2018: Optimal Integration of PARP Inhibitors for Prostate Cancer: Which Test, Which Patient, and Which Therapy?

Chicago, IL ( Carmel Pezaro, MD gave an excellent overview of PARP inhibitors in prostate cancer (PC). She began by giving some background on DNA damage and repair mechanism. DNA can be damaged by endogenous factors (replication stress, chemical modifications), and exogenous factors (radiation, chemotherapy, UV damage). Fortunately, DNA damage repair (DDR) mechanisms exist that prevent replication collapse. There are approximately 450 genes associated with DDR, whether it is single strand break, or double strand breaks.

ASCO 2018: Nonimmunotherapy Strategies in Advanced Bladder Cancer

Chicago, IL ( Andrea B. Apolo, MD had the opportunity to review abstracts 4503-4505 in the context of non-immunotherapy strategies in advanced and metastatic bladder urothelial cancer (mUC). The abstracts presented represented significant advances in the field and were very exciting results in a space that has had few successes in the past. 

First, Apolo reiterated what all three presenters had previously noted:  Despite 5 immune-checkpoint inhibitors (ICI) being approved in the 2nd line setting for patients with mUC who have failed platinum-based chemotherapy, with an objective response rate between 15-20% and OS ~10 months, there is a significant population of patients that do NOT benefit from ICI’s

ASCO 2018: Radiopharmaceuticals: Emitting the Right Signals in Prostate Cancer

Chicago, IL ( Martin Pomper, MD gave an overview of the use of radiopharmaceuticals in prostate cancer (PC). The outline of the talk included a discussion on the various low molecular-weight agents for imaging PC, PSMA targeted imaging, and prostate cancer as a target for immunotherapy.
Imaging in general decreases mortality (for example when used in cancer screening, such as mammography), decreases cost through accurate and prompt diagnosis (eliminating inappropriate surgery), and decreases length of an episode of care (accurate therapeutic monitoring). Imaging can significantly help in early detection, and aside from saving lives, it can significantly reduce costs. A permanent 10% reduction in cancer mortality rates would be worth 4.7$ trillion dollars to current and future Americans.

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