ASCO 2018: Biochemical Recurrence: Judicious Clinical Management of an Evolving Disease State
Chicago, IL (UroToday.com) Alicia Morgans, MD gave an excellent talk on biochemical recurrence (BCR) in prostate cancer (PC) patients. The learning objectives of her talk included being able to recognize subsets of patients with BCR who may benefit the most from early treatment with androgen deprivation therapy (ADT), understanding the plethora of ADT complications, discovering the limitation of data available for considering the optimal timing of ADT in BCR, and lastly, recognizing that treatment of non-metastatic castrate resistant PC (M0CRPC) with novel androgen receptor (AR) directed therapy, is associated with prolonged metastasis free survival (MFS).
ASCO 2018: KEYNOTE-046: ADXS-PSA Plus Pembrolizumab in Metastatic Castration-Resistant Prostate Cancer
Chicago, IL (UroToday.com) In 2018 there will be approximately 165000 new prostate cancer patients with 29000 associated deaths. Patients with metastatic castrate resistant prostate cancer (MCRPC) have especially poor outcomes with median overall survival (OS) of less than 2 years and a 5 year (OS) of only 30%. Studies of therapeutic vaccines in the treatment of prostate cancer have demonstrated improved survival (4.1 months improvement in median OS compared to placebo).
ASCO 2018: RESORT - A Randomized, Open Label, Multicenter Phase 2 Study, to Evaluate the Efficacy of Sorafenib in Patients with mRCC after a Radical Resection of the Metastases
Chicago, IL (UroToday.com) Giuseppe Procopio, MD, from Milan, Italy provided results from the RESORT trial, a phase II trial evaluating the efficacy of sorafenib in patients with mRCC after resection of metastases. The integration between surgery and medical treatment for these patients is debated, as radical metastasectomy could play a role in selected cases.
ASCO 2018: Patient Preference Between Darolutamide and Enzalutamide in Men with Metastatic Castration-resistant Prostate Cancer: ODENZA
Chicago,IL (UroToday.com) The past few decades have seen a rapid expansion of the treatment armamentarium for patients with advanced/metastatic prostate cancer. Where docetaxel used to be the only option for metastatic castration-resistant prostate cancer (mCRPC), there are now numerous therapeutic options – including ARAT (androgen-receptor axis targeted therapies) such as enzalutamide (enza) and abiraterone (AA), as well as Ra-223, sipaleucel-T, etc. Yet, even these agents have begun to make their way into treating the disease in earlier stages, with recent studies demonstrating benefit even in de novo hormone-naïve metastatic prostate cancer.
ASCO 2018: Precision Risk Stratification and Treatment in Biochemical-Recurrent Prostate Cancer
Chicago, IL (UroToday.com) Daniel Spratt, MD gave a good overview on the treatment of biochemical recurrent prostate cancer (PC). Recurrent PC is an increasing common entity with an estimated 45,000 cases/year. Due the decrease of PSA screening since the US task force recommendation in 2012, there has been a decrease in the incidence of low grade PC, while there has been an increase in the incidence of high grade PC. The use of surgery for high risk PC is much more common than the use of radiotherapy, and there are very low rates of adjuvant radiotherapy given (8%) to these high risk surgically treated patients.
ASCO 2018: Lifting the Veil on Micrometastatic Disease: Emerging Imaging Strategies in Biochemical Recurrence
Chicago, IL (UroToday.com) Michael Norris, MD gave a most interesting discussion on emerging imaging strategies in prostate cancer patients with biochemical recurrence (BCR). BCR is a clinical state defined by the performance characteristics of imaging. PSA is a highly sensitive biomarker, and the leading indicator of recurrence to date. Bone scans are however, insensitive, and require the disease to induce blastic changes. Furthermore, it is a lagging indicator of BCR. Importantly, local detection of disease does not preclude the presence of distant disease.
ASCO 2018: Sunitinib Alone Shows Non-inferiority Versus Standard of Care in mRCC - The CARMENA Study
Chicago, IL (UroToday.com) Cytoreductive nephrectomy, essentially debulking of the primary tumor in the setting of metastatic renal cell carcinoma (mRCC), has been a mainstay of therapy for decades. In the IL-2/immunomodulator era, Flanigan et al. (NEJM 2001, JUrol 2004) and Mickisch et al. (Lancet 2001) demonstrated that removal of the kidney was associated with improved overall survival (OS). As a result, it has become an established paradigm in the management of mRCC, and patients who are surgically fit, are often recommended for cytoreductive nephrectomy prior to systemic therapy.