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Highlights from the 2024 ASCO Genitourinary Cancers Symposium |
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| Long-Term Results of Dose Escalation (80 vs 70 Gy) Combined with Long-Term ADT in High-Risk Prostate Cancer: GETUG-AFU 18 Randomized Trial
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| Christophe Hennequin, MD, Ph.D.
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| Christophe Hennequin presented the GETUG-AFU 18 trial showing that dose escalation combined with long-term ADT significantly improves PFS, prostate cancer-specific survival, and overall survival in high-risk prostate cancer. Importantly, these positive outcomes were achieved without an increase in toxicity, establishing high-dose radiotherapy with long-term ADT as a new standard of care for high-risk localized prostate cancer.
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| Patient-Reported HRQoL in the Randomized FORMULA-509 Trial of Salvage Radiotherapy and 6 Months of GnRH Agonist with Either Bicalutamide or Abiraterone Acetate + Prednisone and Apalutamide After Radical Prostatectomy |
| Karen E. Hoffman, MD |
| Karen Hoffman discussed the FORMULA-509 trial and the addition of abiraterone acetate + prednisone + apalutamide to salvage radiotherapy + 6 months of ADT improved oncologic outcomes without causing a detectable difference in patient-reported hormonal function, sexual function, fatigue, or mental status through 1 year after treatment compared to bicalutamide. The favorable patient-reported health-related quality of life outcomes suggest that six months of intensified ADT with next-generation anti-androgens is an attractive treatment alternative to long-duration ADT for patients with rising PSA and unfavorable features after prostatectomy. |
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| Is There a Role for Stereotactic Radiotherapy in Selected Patients With Metastatic Castrate-Resistant Prostate Cancer? |
| Valerie Fonteyne, MD, Ph.D. |
| Valerie Fonteyne discussed the potential role of stereotactic body radiotherapy in selected patients with metastatic castrate-resistant prostate cancer. While SBRT has been primarily explored to reduce treatment burden and maintain safety compared to conventional regimens, there's evidence suggesting its role in managing pain and improving health-related quality of life. |
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| Underutilization of ADT Intensification for the Treatment of Men with mHSPC: A Systematic Review of Real-World Database Studies |
| Peter Goebell, MD, Ph.D. |
| Peter Goebell presented findings on the underutilization of androgen deprivation therapy (ADT) intensification for the treatment of men with metastatic hormone-sensitive prostate cancer. A systematic review of 29 real-world studies, covering 344,473 men from 2015 to 2021, revealed an increasing trend in ADT intensification, particularly with androgen receptor pathway inhibitors. |
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| Post Hoc Analysis of rPFS and OS from the TALAPRO-2 (TP-2) Study: Genomic Subgroups Based on Likelihood of BRCA or HRR Gene Alteration Status |
| Neal Shore, MD, FACS |
| Neal Shore presents a post-hoc analysis of TALAPRO-2 study outcomes. The study evaluated talazoparib and enzalutamide in first-line treatment for mCRPC patients, with biomarker unselected cohorts. The analysis, stratified by genomic subgroups based on the likelihood of BRCA or HRR gene alteration status, revealed benefits in rPFS and OS for BRCAm and HRRm subgroups, with a trend toward improved OS in non-BRCAm and non-HRRm subgroups, suggesting potential benefits for talazoparib addition to enzalutamide in these cohorts. |
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| Radiographic Progression Without PSA Progression in Metastatic Hormone-Sensitive Prostate Cancer: A Retrospective Analysis from the ENZAMET Trial (ANZUP 1304) |
| Ian Davis, Ph.D., FRACP, MBBS, FAChPM |
| Ian Davis presented a post-hoc analysis from the ENZAMET trial, focusing on metastatic hormone-sensitive prostate cancer patients. The analysis explored the incidence of radiographic progression in the absence of PSA progression and revealed that 10% of the cohort experienced radiographic progression without prior PSA progression. |
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| Mature Results of a Phase 2 Pilot Study of Radium-223 and Radiotherapy in Untreated Hormone-Naïve Men with Oligometastatic Prostate Cancer to Bone |
| Jonathan Tward, MD, Ph.D., FASTRO |
| This study presented by Jonathan Tward evaluated the combination of Radium-223 and SBRT in delaying the initiation of androgen deprivation therapy (ADT) while maintaining quality of life. The results showed a significant delay in ADT use, well-tolerated combinatory therapy, preserved quality of life, and the potential for undetectable PSA, highlighting the promise of this approach. |
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| The Survival Outcomes for Men with mCRPC with and Without Homologous Recombination Deficiencies Treated with Radium-223: Princess Margaret Cancer Centre Experience
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| Esmail M. Al-Ezzi, MBBS
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| Esmail Al-Ezzi presented a single-center analysis evaluating the survival outcomes of mCRPC patients treated with Radium-223, stratified by the presence or absence of homologous recombination repair (HRR) deficiencies. The retrospective study, conducted at the Princess Margaret Cancer Centre, suggested that mCRPC patients with HRR mutations treated with Radium-223 exhibited superior overall survival compared to those without HRR mutations.
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| Building a Predictive Model for Outcomes with [177Lu]Lu-PSMA-617 in Patients with Metastatic Castration-Resistant Prostate Cancer Using VISION Data: Preliminary Results |
| Ken Herrmann, MD |
| Ken Herrmann presented preliminary results on building a predictive model for outcomes with [177Lu]Lu-PSMA-617 in patients with metastatic castration-resistant prostate cancer using data from the phase III VISION trial. The analysis aimed to identify baseline parameters predicting clinical outcomes after [177Lu]Lu-PSMA-617 treatment, including overall survival, radiographic progression-free survival, and PSA50 response. |
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| Estimating Median Overall Survival of Apalutamide Compared to Placebo in Metastatic Hormone-Sensitive Prostate Cancer Populations: Statistical Extrapolations of the TITAN Study |
| Neeraj Agarwal, MD |
| Neeraj Agarwal presented an analysis estimating the median overall survival of metastatic hormone-sensitive prostate cancer patients treated with apalutamide versus placebo using statistical extrapolations of the TITAN study. The TITAN trial demonstrated a significant OS benefit with apalutamide, but the median OS was not reached at the time of the final analysis. |
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| Barriers and Facilitators to First-Line Treatment Intensification in Metastatic Castration-Sensitive Prostate Cancer: The IMPLEMENT Study |
| Stacy Loeb, MD |
| Stacy Loeb presented the results of the IMPLEMENT Study aimed to evaluate barriers and facilitators to first-line treatment intensification in patients with mCSPC. Despite evidence and guidelines supporting treatment intensification, there is an implementation gap in clinical practice. The study involved interviews with 36 US urologists and oncologists managing mCSPC patients. Identified barriers included poor knowledge, habit, anticipated regret, costs, and reserving treatment intensification for later use. |
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| Rate of Hospitalization and Length of Hospital Stay During and Post Docetaxel for Darolutamide in Metastatic Hormone-Sensitive Prostate Cancer Using ARASENS |
| Alicia Morgans, MD, MPH |
| In a secondary analysis of the ARASENS trial presented by Alicia Morgans, the rate of hospitalization and length of hospital stay during and post-docetaxel for darolutamide-treated patients with mHSPC were assessed. The international phase 3 trial demonstrated that darolutamide in addition to androgen deprivation therapy and docetaxel significantly reduced the rate of death in mHSPC patients. |
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