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Prostate Cancer Highlights from the 2021 Genitourinary Cancers Symposium |
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| Progress and Promise in Treatment Personalization for Advanced Prostate Cancer |
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| PARP Inhibitors – Is It A Sea Change or Just Another Incremental Change?
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| Peter Nelson, MD
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| Peter Nelson discussed the evidence leading to the approval of the PARP inhibitors olaparib and rucaparib in advanced prostate cancer as well as issues surrounding biomarkers for patient selection. Dr. Nelson stated that PARP inhibitors are clearly a breakthrough with substantial clinical benefit in appropriately selected patients. Refinement of the assays, in part through post-approval studies, used to identify HR deficiency will be critical to best optimize the use of these new therapies.
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| Practical Applications of Novel Imaging and Genomic Approaches in the Management of Clinically Localized Prostate Cancer |
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| Active Surveillance in 2021 and Beyond |
| Peter Carroll, MD |
| Peter Carroll discussed active surveillance for prostate cancer as it stands in 2021. Dr. Carroll notes that active surveillance is a preferred form of treatment for many men, but should be seen, as well, as a response to the over-detection and over-treatment of prostate cancer brought about by widespread and repeated PSA screening. |
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| Welcome to the Wild West: The Impact of FDA Approval of PSMA PET/CT on Prostate Cancer Management |
| Declan G. Murphy, MB, BCH, BaO, FRACS, FRCS |
| Declan Murphy who discussed the Impact of the FDA approval of PSMA PET/CT in prostate cancer management. The FDA approval was recently granted in the United States (US) for use of PSMA PET/CT, but only at two centers: UCLA and UCSF. Since PSMA PET/CT has been used for many years in Australia, Dr. Murphy is able to provide insights into how utilization of this novel imaging technology may look in the US over the coming months/years. |
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| Head-to-Head Comparison of 68Ga-PSMA-11 PET/CT and mpMRI in the Detection, Intra-Prostatic Localization, and Local Extension of Primary Prostate Cancer: A Single-Center Imaging Study With Histopathology Gold-Standard |
| Ida Sonni, MD |
| Ida Sonni presented results of her work in a study comparing the diagnostic performance of PSMA PET/CT, mpMRI and the combination of the two modalities in the detection, intra-prostatic localization, and local extension of primary prostate cancer with histopathology as the gold standard. For this study, patients with intermediate- or high-risk prostate cancer underwent a PSMA PET/CT scan and mpMRI prior to intended radical prostatectomy. |
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| Oral Abstract Session: Prostate Cancer |
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| 177Lu-PSMA-617 Versus Cabazitaxel in Metastatic Castration-Resistant Prostate Cancer Progressing After Docetaxel: Updated Results Including Progression-Free Survival and Patient-Reported Outcomes (TheraP ANZUP 1603) |
| Michael S. Hofman, MBBS (Hons), FRACP, FAANMS, FICIS |
| Michael Hofman presented updated data from the TheraP study, including patient-reported outcomes (PROs) having now met pre-specified event targets. Although overall survival (OS) data remain immature, these updates from TheraP ANZUP1603 continue to indicate activity in and efficacy and safety relative to cabazitaxel in men who have progressive mCRPC after docetaxel treatment. As highlighted by Dr. Hofman, the strengths of these data include an active treatment comparison arm (i.e. cabazitaxel) and a weakness of high rates of withdrawal in that arm. |
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| Molecular Determinants Associated with Long-Term Response to Apalutamide in Nonmetastatic Castration-Resistant Prostate Cancer |
| Felix Y. Feng MD |
| In this presentation, Felix Feng describes the transcriptomic characteristics of the extremes of response in the SPARTAN trial. Time to progression events (metastasis or death) were divided into quartiles, with long term responders defined as no events until the fourth time quartile, and early progressors having events in the first quartile of time. In total, 233 tumors from radical prostatectomy or diagnostic biopsy were included in this biomarker analysis, with a mean time from sample generation to analysis of 6.7 years. |
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| Final Results from ACIS, a Randomized, Placebo-Controlled Double-Blind Phase 3 Study of Apalutamide and Abiraterone Acetate plus Prednisone (AAP) Versus AAP in Patients with Chemo-Naive Metastatic Castration-Resistant Prostate Cancer |
| Dana Rathkopf, MD |
| Dana Rathkopf presented results of the ACIS study. The ACIS trial met its primary outcome of showing an rPFS benefit for abiraterone plus apalutamide as first line therapy in mCRPC, but the secondary endpoint of overall survival and others were similar between the treatment arms. While more treatment related adverse events were noted in the combination arm, the overall QoL as measured by FACT-P was similar between arms. |
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| Rapid Abstract Session: Prostate Cancer |
| Survival Outcomes in Patients with Metastatic Castration-Sensitive Prostate Cancer (mCSPC): A Real-World Evidence Study
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| Stephen J. Freedland, MD
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| Stephen Freedland presented an assessment of utilization and outcomes for patients with mCSPC in the Veterans Health Administration system. The field of advanced prostate cancer has rapidly progressed over the past 15 years. In the past 5 years, there has been considerable development in the treatment of patients with mCSPC, including chemotherapy and novel hormonal therapies. Each of these has proven survival benefits compared to the historic standard of ADT alone.
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| Efficacy of Enzalutamide plus ADT in Men with De Novo (M1) mHSPC Versus Progression to mHSPC: Post Hoc Analysis of the Phase III ARCHES Trial |
| Arun Azad, MBBS, PhD, FRACP |
| Arun Azad presented results of an exploratory analysis at the GU ASCO 2021 meeting evaluating the efficacy of enzalutamide plus androgen deprivation therapy in patients who progressed to M1 HSPC following initial diagnosis (M0) versus patients who presented with de novo mHSPC at diagnosis (M1). |
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| The Impact of Concomitant Prostate Cancer Therapy on Efficacy and Safety of Relugolix vs Leuprolide in Men With Advanced Prostate Cancer: Subgroup Analysis, the Phase III HERO Study |
| Daniel George, MD |
| Daniel George presented a subgroup analysis assessing the impact of concomitant prostate cancer therapy on the safety and efficacy of the oral GnRH receptor antagonist relugolix versus leuprolide in men with advanced prostate cancer in the phase 3 HERO study. |
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| ARTO Trial: A Randomized Phase II Trial Enrolling Oligometastatic CRPC Patients Treated with First-Line Abiraterone Acetate with or without Stereotactic Body Radiation Therapy |
| Giulio Francolini, MD |
| The ARTO trial is a randomized phase II trial testing the benefit of upfront stereotactic body radiation therapy on all sites of metastatic disease in oligometastatic-mCRPC patients undergoing first-line therapy with abiraterone acetate. Giulio Francolini presents a preliminary analysis, reporting results after six months of follow up, together with an exploratory analysis of androgen receptor splice variants (ARV7/ARFL) PSA and PSMA expression on circulating tumor cells detected in this cohort of patients. |
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| Clinical Outcomes of Patients With mCRPC Receiving Radium-223 Early Versus Late in the Treatment Sequence |
| Lawrence Mbuagbaw, MD, MPH, Ph.D. |
| Lawrence Mbuagbaw presented results of a real-world study evaluating clinical outcomes of patients when Radium-223 was used early (second-line) or late (third or later lines) among men with mastatic castration-resistant prostate cancer. Patients who received Radium-223 in second-line versus third-line or later had better outcomes. Additionally, patients who received Radium-223 early received less chemotherapy, but had better survival. |
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| Poster Highlights: Prostate Cancer - Localized Disease |
| Safety of Darolutamide for Nonmetastatic Castration-Resistant Prostate Cancer From Extended Follow-Up in the Phase III ARAMIS Trial
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| Matthew R. Smith, MD, Ph.D.
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| Matthew Smith presented long-term data on the safety of darolutamide from both the double-blind and open-label portions of the ARAMIS trial. With longer durations of follow-up, darolutamide remained well tolerated with no new safety signals.
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| Poster Session: Prostate Cancer - Advanced Disease |
| Cabazitaxel Multiple Rechallenge in Metastatic Castration-Resistant Prostate Cancer: A Therapeutic Option to Increase Overall Survival?
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| Cedric Pobel, MD
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| Cabazitaxel is typically used in the second-line chemotherapy setting. In a plenary abstract presentation in the Poster Highlights Session: Prostate Cancer session at the 2021 Virtual ASCO GU Cancers Symposium, Dr. Pobel and colleagues assess the feasibility and efficacy of cabazitaxel multiple rechallenge in patients with mCRPC.
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| Concordance of BRCA1, BRCA2, and ATM Mutations Identified in Matched Tumor Tissue and Circulating Tumor DNA in Men with Metastatic Castration-Resistant Prostate Cancer Screened in the PROfound Study
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| Kim Chi, MD, FRCPC
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| In plenary abstract presentation in the Poster Highlights Session: Prostate Cancer session at the 2021 ASCO GU Cancers Symposium, Kim Chi evaluated the utility of plasma-derived ctDNA to identify deleterious BRCA and ATM mutations in screened patients from PROfound.
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| Olaparib Efficacy in Patients with Metastatic Castration-Resistant Prostate Cancer Carrying Circulating Tumor DNA Alterations in BRCA1, BRCA2 or ATM: Results from the PROfound Study |
| Nobuaki Matsubara, MD |
| Nobuaki Matsubara presented a retrospective assessment of ctDNA to identify alterations in BRCA1, BRCA2, and ATM among men in the PROfound trial. Based on the data, ctDNA testing in patients with mCRPC is both feasible and, for the most part, concordant with tissue-based assessment of HRR mutation status. Further, responses to olaparib were similar between patients identified as having BRCA/ATM alterations on the basis of ctDNA and those in the overall cohort A. |
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| Efficacy of the PD-L1 Inhibitor Avelumab in Neuroendocrine or Aggressive Variant Prostate Cancer: Results From a Phase II, Single-Arm Study |
| Landon Carter Brown, MD |
| Among men with metastatic castration-resistant prostate cancer, there is a subset who develop aggressive variant or neuroendocrine/small-cell-like tumors. These men display particularly poor outcomes. Although a field of active investigation of underlying mechanisms of development, effective therapies remain a clear unmet clinical need. The current standard of care is typically platinum- or taxane-based chemotherapies. Landon Brown presents a single arm, two-stage phase II trial (PICK-NEPC1) to evaluate whether men these tumors respond to treatment with avelumab, a PD-L1 inhibitor. |
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| To view our full coverage of the 2021 ASCO GU Symposium, visit the Conference Coverage section on UroToday.com
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