ESMO 2018: The Best of Munich 2018 Congress Genitourinary Tumors, Prostate

Munich, Germany ( Silke Gillessen, MD summarized the highlights of prostate cancer studies presented this year in ESMO.  A total of four important prostate cancer studies in three different prostate cancer settings were presented in this session, deemed to be very important by Dr. Gillessen.

ESMO 2018: Invited Discussant - Genomics of Prostate Cancer for Precision Medicine Based on DNA Repair Defects

Munich, Germany ( Joaquin Mateo, MD gave a summary presentation on three major posters presented ESMO 2018. These posters included: 1. 793PD - Preliminary results from TRITON2: a phase 2 study of rucaparib in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC) associated with homologous recombination repair (HRR) gene alterations – Wassim Abida, New York, US. 2. 794PD - Prospective comprehensive genomic profiling (CGP) of 3,476 primary and metastatic site prostate tumors – Siraj Ali, Cambridge, US. 3. 795PD - Genomic profiling of circulating tumor DNA (ctDNA) and tumor tissue for the evaluation of rucaparib in metastatic castration-resistant prostate cancer (mCRPC) – Simon Chowdhury, London, UK

ESMO 2018: Invited Discussant - Detection of Circulating Tumor DNA in mHSPC and LATITUDE Study

Munich, Germany ( Joe O’Sullivan, MD, gave a discussion summarizing two important posters presented at ESMO 2018 in Munich. These included:

  1. 796PD - Detection of circulating tumor DNA in de novo metastatic castrate-sensitive prostate cancer – Werner Strauss et al.
  2. 797PD - LATITUDE study: PSA response characteristics and correlation with overall survival (OS) and radiological progression-free survival in patients with metastatic hormone-sensitive prostate cancer receiving ADT+abiraterone acetate and prednisone or placebo – Nobiaki Matsubara et al.

ESMO 2018: Invited Discussant - mCRPC with High Tumor Mutational Burden and a Phase I Dose-Escalation Study of 177Lu-PSMA-617 for mCRPC

Munich, Germany ( Aristotelis Bamias, MD discussed the following two studies:

  1. 798PD - In-depth assessment of metastatic prostate cancer with the high tumor mutational burden – Niven Mehra et al.
  2. 799PD - Phase I dose-escalation study of fractionated dose 177Lu-PSMA-617 for progressive metastatic castration-resistant prostate cancer (mCRPC) – Scott Tagawa et al.

ESMO 2018: Improving Treatment Outcome by Manipulating the Immune System

Munich, Germany ( Dr. Winald R. Gerritsen gave an overview of the role of immunotherapy in prostate cancer.

There have been several vaccinations that have been specifically developed for prostate cancer. These include:

  • Sipuleucel T – demonstrating a median four months overall survival advantage vs. placebo, with an immune response in 70% of patients
  • G-VAX – Two phase 3 studies comparing it vs. docetaxel had failed

ESMO 2018: Randomized Trial of Androgen Deprivation Therapy + Enzalutamide Versus ADT + Bicalutamide in Metastatic Hormone Sensitive Prostate Cancer

Munich, Germany ( Enzalutamide is an androgen signaling inhibitor which prevents androgen receptor nuclear translocation and DNA binding, therefore leading to cellular apoptosis.  Enzalutamide has been largely studied in the metastatic castration-resistant population, demonstrating an overall survival benefit for patients before and after chemotherapy1,2. In an open-label, single arm, phase II study, enzalutamide was also found to be well tolerated in patients with castration-sensitive prostate cancer, with 92.5% of patients achieving at 80% PSA decline or greater by week 25 of therapy3. However, it is unknown if enzalutamide is more effective than bicalutamide in combination with standard ADT for patients with metastatic castration sensitive prostate cancer. 

ESMO 2018: Cabazitaxel Treatment in mCRPC Clinical Trials Compared to Usual Care In CAPRI: An Observational Study In The Netherlands

Munich, Germany ( TROPIC was a randomized open label phase III clinical trial which compared the efficacy of cabazitaxel to mitoxantrone in patients with mCRPC who had progressed on docetaxel1. 755 men were randomized and included in the intention to treat analysis. At the time of final analysis, cabazitaxel improved overall survival (15.1 vs 12.7 months, HR 0.7, p<0.0001) as well as median progression free survival.

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