The cover story, An Unmet Need is Met: (The PROSPER Study): Evaluating the Safety and Efficacy Study of Enzalutamide in Patients with Nonmetastatic Castration-Resistant Prostate Cancer discusses 2 phase III nmCRPC trials and how they will significantly alter the evaluation and treatment for nmCRPC patients. At ASCO GU 2018, these two phase III presentations were highly anticipated and, assuredly, exceeded the expectations of most researchers and clinicians:PROSPER: A phase III, randomized, double-blind, placebo-controlled study of enzalutamide in men with M0 prostate cancer, and SPARTAN, a phase III double-blind, randomized study of apalutamide versus placebo in patients with nonmetastatic castration-resistant prostate cancer. For men with nm CRPC (M0 CRPC), who are invariably at risk of metastasis, both the PROSPER and SPARTAN trials clearly demonstrated that combining their respective oral, once daily AR inhibitor with androgen-deprivation therapy (ADT) resulted in markedly prolonging metastasis-free survival in comparison to ADT plus placebo. Thus, no longer is there a lack of level one evidence for treating the AUA CRPC Guidelines index case one patient.
The Expert Perspective by Anil Kapoor, How I Manage First-Line Therapy for Advanced Kidney Cancer, discusses initial considerations and first line targeted therapies for the treatment of advanced and metastatic renal cell carcinoma (RCC). Additionally, Dr. Kapoor discusses evaluating, selecting, and monitoring both TKI and IO therapeutics; he also reviews the ongoing trials in RCC. His many years of experience as a Urologic Oncologist who has championed the importance of establishing an Advanced Kidney Cancer Clinic of excellence is well described.
Our Clinical Update, by Arjun Balar, Bladder Cancer Immunotherapy: Establishing a Clinic of Excellence is a timely review of the five currently FDA approved immune checkpoint inhibitors available for the treatment of locally advanced or metastatic urothelial carcinoma patients that have progressed during or after platinum-based chemotherapy. The checkpoint inhibitors, or PD-1 pathway inhibitors, have demonstrated remarkable and durable responses, with an overall well-established tolerability profile, albeit with important and unique immune-related adverse events which must be considered. Unfortunately, the majority with advanced or mUC may not respond to IO therapy; however, there are numerous combinatorial strategies in trial development which could potentially overcome this challenge.
Finally, this issue’s Spotlight section features articles from the key presentations from ASCO GU 2018 in the areas of prostate, bladder and kidney cancer. Highlights include the keynote lecture on Urothelial Carcinoma: Immune Checkpoint Inhibitors: Which One and Why? and in prostate cancer: The FALCON Trial: Impact of 18F-fluciclovine PET/CT on Clinical Management Choices for Men with Biochemically Recurrent Prostate Cancer.
Thank you for reading this year’s inaugural edition; we look forward to sharing with you the upcoming breakthroughs in 2018.
Neal Shore, MD, FACS
Further Related Content:
PROSPER Clinical Trial (NCT02003924)