Welcome back to Everyday Urology - Oncology Insights. As is our journal’s goal, this issue will illuminate recent advances within the management armamentarium of Urologic Oncology by featuring clinical care updates and expert opinions. In this issue, Everyday Urology focuses on advanced prostate cancer, highlighting recent additions to the nmCRPC treatment landscape as well as the emerging role of theranostics. Finally, our spotlight features coverage of the Advanced Prostate Cancer Consensus Conference, (APCCC 2019) held August 29 - 31, 2019 in Basel, Switzerland.
In “Darolutamide: Approved for Non-MetastaticCastration-Resistant Prostate Cancer,” I discuss the approval of darolutamide for the treatment of high risk non-metastatic castration-resistant prostate cancer. The third oral therapy now approved for nmCRPC, the mechanism of action of darolutamide is virtually identical to earlier approved androgen receptor (AR) antagonists, however, it has demonstrated an inhibitory effect in AR variants resistant to apalutamide and enzalutamide as well as a very favorable toxicity profile. This approval has led to an expansion of the treatment armamentarium for nmCRPC, a disease previously managed by surveillance and observation, prior to the approvals of apalutamide and enzalutamide in 2018.
Philip J. Koo, MD, discusses the potential of PSMA-targeted radioligand therapies for mCRPC in our cover story, “Preparing Your Practice for the New Era of Theranostics.” (LINK PHIL'S ARTICLE) Incorporating antibody conjugates with radiopharmaceuticals has been widely practiced in Germany. Dr. Koo reviews the prospective international, multicenter, randomized, phase 3 VISION trial which began in May 2018, and just completed trial accrual this month. The trial results may herald the first-in-class approval of theranostics in the United States. The VISION trial enrolled 750 patients with PSMA-positive, progressive (having received a novel hormonal agent as well as a taxane therapy), which were randomized to receive best supported care or up to six cycles of 7.4 GBq (±10%) 177Lu-PSMA-617. If theranostics are approved, ongoing combinatorial trials with existing approved mCRPC therapies will further augment our ongoing and still unclear optimal road map for sequencing therapies.
During the last week in August, prostate cancer specialists from across the globe gathered in Basel, Switzerland for the Advanced Prostate Cancer Consensus Conference (APCCC). The meeting, held for the third time since its conception in 2015, gathered leading experts in a robust multidisciplinary assembly to review, debate and vote on over 100 questions of controversy affecting prostate cancer care and management. Topics included disparities in cancer care accessibility, emerging treatments, care paradigms for metastatic hormone sensitive prostate cancer, as well as the management of treatment side effects, and ultimately, voting was recorded for publication, which will be published and available before this year ends. UroToday also traveled to Basel, gathering exclusive audio and written content from the meeting including exceptional videos with numerous key panelists, now featured on the UroToday website.
Just as the 3rd APCCC meeting helped to establish an expert consensus on challenging issues facing prostate cancer care, we hope this issue will bring further awareness to recent advances in prostate cancer research and management. Thank you for reading Everyday Urology - Oncology Insights.
Written by: Neal Shore, MD, FACS, Medical Director of the Carolina Urologic Research Center. He practices with Atlantic Urology Clinics in Myrtle Beach, South Carolina.