Advancing the Evidence of Personal Medicine - Imaging, Genomics, and Biomarkers ASCO 2019
Urology News and Education Resource
Sunday, 05 July 2020
Biomarker Analyses from JAVELIN Renal 101: Avelumab + Axitinib Versus Sunitinib in Advanced Renal Cell Carcinoma
Dr. Toni Choueiri presented results of the biomarker analysis performed on patients participating in JAVELIN Renal 101. This study consisted of four biomarker analyses: PD-L1 expression (n=804), CD8 expression (n=795), A novel 26-gene JAVELIN gene signature (n=720), Mutations and polymorphisms (n=733).
Case Closed: CARMENA Puts an End to Unnecessary Surgery
In this presentation, Dr. Uzzo discussed the role of cytoreductive nephrectomy in the post-CARMENA era. He admits that, even in his center, with excellent medical oncologists and surgeons who know their literature, there is still uncertainty on a case-by-case basis on the need for CNx.
Guest Speaker's Address: Will We Be Technicians or Counselors?
Dr. Atul Gawande, an endocrine surgeon and surgical oncologist at the Brigham and Women’s Hospital and world-renowned author of four best-selling books: Complications, Better, The Checklist Manifesto, and Being Mortal: Medicine and What Matters in the End gave the ASCO 2019’s guest speaker address. His talk entitled “Will We Be Technicians or Counselors?” centers around the experience he had with his daughter’s piano teacher who was diagnosed with rhabdomyosarcoma.
Cytoreductive Nephrectomy Still an Important Tool in Management of Metastatic Renal Cell Carcinoma
Sarah Psutka presented current evidence supporting the continued role of cytoreductive nephrectomy in the management of metastatic RCC. In the IL-2/immunomodulator era, the removal of the kidney was associated with 6 month improved overall survival benefit. 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.
Urothelial and Variant Cases
Current Approaches to Urothelial and Variant Cancers: Tumor Board Presentation
Dr. Jeanny B. Aragon-Ching kicked off this session, focusing on variant histology. She noted that 25% of pathology specimens may have variant histology or divergent differentiation, more common than we sometimes expect. The most common is squamous differentiation (60%) and glandular differentiation (10%), then sarcomatoid (7%) and micropapillary (3.6%). Others include small cell, plasmacytoid, nested, and lymphoepithelioma-like. She addressed the data on each of these briefly.
Treatment of Cisplatin-ineligible Patients with Radiotherapy
A Radiation Oncologist Perspective
Dr. Ananya Choudhury's presentation focused on the role of radiotherapy in patients who are cisplatin ineligible. She asserted that radiotherapy outcomes are equivalent to surgery. The updated NCCN guidelines now support this by listing chemoradiation as an equal first-line option for patients with stage II cT2N0 urothelial carcinoma of the bladder.
Cisplatin-ineligible Patients with Urothelial Carcinoma
A Medical Oncologist Perspective
Dr. Evan Yu focused his presentation on cisplatin-ineligible patients with urothelial carcinoma. First, what is cisplatin-ineligibility? All major national and international guidelines recommend against neoadjuvant therapy if patients are cisplatin ineligible. Many specifically state that carboplatin should not be substituted in this setting.
Treatment Decisions in Upper Tract Urothelial Carcinoma
A Urologic Oncologist Perspective
In this presentation, Dr. Vitaly Margulis focuses on UTUC. He started by presenting a clinical case of a 75 year old man who presents with a radiographically evident 2.5 cm left renal pelvis tumor, cN0. Biopsied and found to be high-grade. He has no evidence of metastatic disease. eGFR is 65. He asked the audience what they would do – nephroureterectomy (open or MIS) or chemotherapy. While there wasn’t much of a response, the few that responded recommended neoadjuvant chemotherapy.
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