Conferences

ESMO 2021: AI, Targeted Data and Predictive Analytics to Monitor and Proactively Manage Patient Outcomes and Validate the Quality and Benefit of Cancer Care

(UroToday.com) In this presentation, Dr. Mozzi Etemadi discussed how computer programs, often referred to as artificial intelligence, can be used for cancer-based applications such as cancer screening.

ESMO 2021: How Patients Can Support the Qualitative Empirical Data and Strengthen Cancer Health Research

(UroToday.com) In this presentation, Mr. Geissler, a long-time cancer survivor and patient advocate discussed how qualitative data from patients can strengthen cancer research. He began by describing the difficult trade-offs that are often the norm for cancer patients: choosing between either proven or unknown therapies that have a range of side effects that can range from bad to ugly. Researchers and institutions can utilize the unique insights of the patient community to further understand these trade-offs. Patients can enunciate what true “unmet needs” are in a disease, and what they find valuable. Discussing these perspectives can help identify information gaps that hinder informed decision-making, understand how diagnostics and side effects impact quality of life, and what other practice challenges exist in cancer care.

AIBCCR 2021: Going Beyond BCG to Exploit Immunomodulation for Bladder Cancer

(UroToday.com) The final session of the 7th Annual AIBCCR Symposium, chaired by Dr. Molly Ingersoll (Institut Pasteur), explored ways of going beyond BCG to exploit immunomodulation for bladder cancer. Dr. Ingersoll set the scene for the session by highlighting the urgent need for alternative treatment approaches to BCG, referencing a recent publication that demonstrated increased recurrence and cost of care in patients with intermediate- and high-risk NMIBC as a result of the global BCG shortage.1

ESMO 2021: Quality of Life and Long-Term Comorbidities

(UroToday.com) The Earlier Treatment in Prostate Cancer “How can we maximize the therapeutic index?” educational session at the European Society for Medical Oncology (ESMO) 2021 congress included a presentation by Dr. Heather Payne discussing quality of life and long-term comorbidities. Dr. Payne started by highlighting what quality of life means for our patients. Indeed, quality of life has multiple definitions, including the patient’s subjective report of their health status, their overall enjoyment of life, a measure of an individual’s sense of well-being and ability to carry out various activities, and the extent to which hopes and ambitions are matched by experience. Quality of life also has multiple domains, including physical, emotional/psychological, social functioning, level of independence, environmental (ie. financial resources, home, freedom), spirituality/religion, and others.

ESMO 2021: Enhanced Androgen Signalling Inhibition Should Be the Treatment of Choice for Treatment of mCSPC Rather than Docetaxel - Yes

(UroToday.com) In the Controversy session of the European Society for Medical Oncology (ESMO) Annual Congress, Dr. Karim Fizazi and Dr. Ronald De Wit debated the question of whether enhanced androgen signaling inhibition should be the treatment of choice for treatment of metastatic castration sensitive prostate cancer (mCSPC) rather than docetaxel. Presenting first, Dr. Fizazi took the position that androgen signaling inhibition should be the treatment of choice, though he emphasized that potentially these approaches should be considered in combination.

ESMO 2021: Enhanced Androgen Signalling Inhibition Should Be the Treatment of Choice for Treatment of mCSPC Rather than Docetaxel - No

(UroToday.com) In the Controversy session of the European Society for Medical Oncology (ESMO) Annual Congress, Dr. Karim Fizazi and Dr. Ronald De Wit debated the question of whether enhanced androgen signaling inhibition should be the treatment of choice for treatment of metastatic castration sensitive prostate cancer (mCSPC) rather than docetaxel. Presenting second, Dr. de Wit supported the use of docetaxel.

ESMO 2021: Are Adjuvant Immune Checkpoint Inhibitors a Standard of Care for Operable High-Risk Urothelial and Kidney Cancer? No

(UroToday.com) The European Society of Medical Oncology (ESMO) 2021 annual congress included a controversial session highlighting ‘Are adjuvant immune checkpoint inhibitors a standard of care for operable high-risk urothelial and kidney cancer?’ Dr. Michiel van der Heijden discussed that no, adjuvant immune checkpoint inhibitors are not standard of care. Dr. van der Heijden started by highlighting that spring 2021 was a happy time: the daily COVID numbers were decreasing, KEYNOTE-564 was presented at ASCO, and CheckMate 274 was published in the New England Journal of Medicine.1 Taking a step back, it is important to remember that the goal of adjuvant therapy is to prevent disease recurrence and death, with the knowledge that a proportion of patients will be treated for a disease that was cured with surgery alone. As such, disease-free survival does not necessarily mean a survival benefit just that the time to disease recurrence was delayed.

ESMO 2021: Are Adjuvant Immune Checkpoint Inhibitors a Standard of Care for Operable High-Risk Urothelial and Kidney Cancer? Yes

(UroToday.com) The European Society of Medical Oncology (ESMO) 2021 annual congress included a controversial session highlighting ‘Are adjuvant immune checkpoint inhibitors a standard of care for operable high-risk urothelial and kidney cancer?’ Dr. Thomas Powles discussed that yes, adjuvant immune checkpoint inhibitors are standard of care. At the moment, there is no approved neoadjuvant or adjuvant therapy for patients with high-risk kidney cancer, but there are several scoring systems to risk-stratify patients. The KEYNOTE-564 trial1 is the first adjuvant checkpoint inhibitor in the adjuvant disease space. Patients randomized to pembrolizumab had a significant disease-free survival benefit compared to those treated with placebo in the intention-to-treat population (HR 0.68, 95% CI 0.53-0.87):

ESMO 2021: The Role of Imaging in Selecting Treatment

(UroToday.com) The Earlier Treatment in Prostate Cancer “How can we maximize the therapeutic index?” educational session at the European Society of Medical Oncology’s (ESMO) 2021 congress included a presentation by Dr. Piet Ost discussing the role of imaging in selecting treatment. Dr. Ost notes that it is important to highlight that the Will Rogers phenomenon is present in prostate cancer. For example, high-risk localized prostate cancer patients that are negative with conventional imaging will have a proportion of patients that will be PET/CT positive and move to the oligometastatic cohort of patients. Thus, this shift will improve outcomes of the localized high-risk patients by removing those that are truly oligometastatic, but also improving outcomes of metastatic patients by adding low-volume oligometastatic patients to this group. As such, these are artificial improvements in outcomes-based novel imaging leading to stage migration.

ESMO 2021: Evidence-Based Treatment Options in Biochemically Relapsed Prostate Cancer

(UroToday.com) The Earlier Treatment in Prostate Cancer “How can we maximize the therapeutic index?” educational session at the European Society of Medical Oncology’s (ESMO) 2021 congress included a presentation by Nicolas Mottet discussing evidence-based treatment options in biochemically relapsed prostate cancer. Dr. Mottet notes that the definition of relapse after external beam radiotherapy is the nadir + 2 ng/mL, with the rationale for this being that it was the best definition to predict further metastases. It was initially based on the Phoenix consensus but later was considered as the main clinical definition of relapse. With regards to relapse after radical prostatectomy, Dr. Mottet notes that there is a major difference between PSA relapse (any PSA rise following an undetectable level) and a clinically significant PSA rise, which is the best predictor of further metastases. Post-radical prostatectomy, the definition of relapse is no longer a PSA of 0.2 ng/mL and rising. Currently, following an undetectable PSA (<0.1 ng/mL), the best PSA threshold to define a relapse is 0.4 ng/mL and rising (since 2018 EAU-ESTRO-SIOG-ESUR guideline), given that this is the best correlation with systemic progression; this definition has also been adapted as a consensus statement by ASCO. The threshold of PSA > 0.4 ng/mL and rising is the most clinically relevant threshold, but it is not the threshold to define relapse, and it is not the threshold to consider salvage treatment.

ESMO 2021: Future Targets and Combinations for Metastatic Renal Cell Carcinoma

(UroToday.com) The Realizing Potential Combination and Personalized Therapy educational session at the European Society of Medical Oncology’s (ESMO) 2021 congress included a presentation by Dr. Cristina Suarez discussing the future targets and combinations for metastatic RCC. These unique combinations include alternative proangiogenic pathways, immunotherapies/enhancing immune checkpoint inhibitors, metabolic pathways, and PARP inhibitors.

ESMO 2021: Current Status of Personalized Therapy in Metastatic Renal Cell Carcinoma

(UroToday.com) The Realizing Potential Combination and Personalized Therapy educational session at the European Society of Medical Oncology’s (ESMO) 2021 congress included a presentation by Dr. Manuela Schmidinger discussing the current status of personalized therapy in metastatic RCC. Dr. Schmidinger notes that the reason we need personalized therapy in metastatic RCC is that there are currently four competing strategies for IMDC intermediate-poor risk patients and three options for favorable risk. Given the wealth of novel treatment options, multiple questions arise: (i) what is the role of single-agent TKI? In favorable-risk patients there is no OS advantage for single-agent TKI, however, the complete response rate is twice as high; (ii) If ICI-based therapies are the backbone, should we be offering ICI doublets or ICI/TKI combination therapy? (iii) If we are using ICI-only treatment, does it always mean it has to be a doublet? (iv) If ICI/TKI double therapy, which TKI should we use? (v) Do some patients need something totally different than the current clinical trials we have?

ESMO 2021: Invited Discussant: Decreasing Morbidity for the Treatment of Stage II Seminoma

(UroToday.com) The 2021 European Society of Medical Oncology’s (EMSO) annual congress included a proffered paper session in non-prostate genitourinary tumors, as well as a discussant presentation by Dr. Christian Kollmannsberger discussing decreasing morbidity for the treatment of stage II seminoma. The abstract discussed was “Single-dose carboplatin followed by involved-node radiotherapy as a curative treatment for seminoma stage IIA/B: Efficacy results from the international multicenter phase II trial SAKK 01/10” by Dr. Alexandros Papachristofilou. Indeed, the price for a cure in testicular cancer is often at the cost of long-term morbidity/mortality from treatment. The SAKK 01/10 trial attempted to decrease treatment burden while maintaining cancer efficacy. This trial is a multicenter, single-arm, phase II study in patients with clinical stage IIA/B seminoma (de novo or relapse on active surveillance). Treatment consisted of 1 cycle carboplatin AUC7 followed by involved-node radiotherapy (IIA: 30 Gy; IIB: 36 Gy) with a primary endpoint of 3-year PFS:

ESMO 2021: Is There an Optimal First-Line Combination Approach for Metastatic mRCC?

(UroToday.com) The Realizing Potential Combination and Personalized Therapy educational session at the European Society for Medical Oncology (ESMO) 2021 congress included a presentation by Dr. Toni Choueiri discussing whether there is an optimal first-line combination approach for metastatic renal cell carcinoma (RCC). The current first-line combination therapies that are FDA approved are listed as follows:

ESMO 2021: Invited Discussant: Modified Delivery of RCC Therapy: Can we Maintain Efficacy and Improve Quality of Life?

(UroToday.com) The 2021 European Society of Medical Oncology’s (EMSO) annual congress included a proffered paper session in non-prostate genitourinary tumors, as well as a discussant presentation by Dr. Brian Rini discussing maintaining efficacy and improving quality of life in the delivery of RCC therapy. Dr. Rini discussed three excellent abstracts: “Pembrolizumab versus placebo as adjuvant therapy for patients with RCC: Patient-reported outcomes (PROs) in KEYNOTE-564” by Dr. Toni Choueiri, “Nivolumab in combination with alternatively scheduled ipilimumab in first-line treatment of patients with advanced RCC: A randomized phase II trial (PRISM)” by Dr. Naveen Vasudev, and “STAR: A Randomized Multi-Stage Phase II/III Trial of Standard first-line therapy (sunitinib or pazopanib) Comparing Temporary Cessation with Allowing Continuation, in the treatment of locally advanced and/or metastatic RCC” by Dr. Janet Brown.

ESMO 2021: CheckMate 9KD Cohort A2 Final Analysis: Nivolumab + Rucaparib for Chemotherapy-Naïve Metastatic Castration-Resistant Prostate Cancer

(UroToday.com) In this presentation, Dr. Daniel Petrylak discussed results from the final analysis of CheckMate 9KD Cohort A2. This single-arm study evaluated the clinical activity of nivolumab plus rucaparib in men with metastatic castration-resistant prostate cancer (mCRPC) previously untreated with chemotherapy or PARP inhibitor. Patients eligible for Cohort A2 were not candidates for or refused chemotherapy. Eligible patients received nivolumab 480 mg every 4 weeks and rucaparib 600 mg BID. The co-primary endpoints were overall response rate (ORR) and PSA response rate.

ESMO 2021: Phase Ib/II Study of Sabizabulin (VERU-111), an Androgen Receptor Transport Disruptor, in Men with Metastatic Castration Resistant Prostate Cancer (mCRPC) Who Failed an Androgen Receptor Targeting Agent

(UroToday.com) In this presentation, Dr. Mark Markowski discussed results of a Phase 1b/2 study of sabizabulin (VERU-111), an androgen receptor transport disruptor, in men with metastatic castration resistant prostate cancer (mCRPC) who failed an androgen receptor targeting agent (ARTA). Sabizabulin is an oral agent that inhibits microtubule assembly as well as disrupts androgen receptor transport from the cytoplasm to the nucleus.

ESMO 2021: Darolutamide Maintenance in Metastatic Castration Resistant Prostate Cancer Previously Treated with Novel Hormonal Agents and Non-Progressive Disease After Subsequent Treatment with a Taxane: SAKK 08/16

(UroToday.com) In this presentation, Dr. Richard Cathomas presented results from SAKK 08/16, a randomized double-blind placebo-controlled phase II trial of darolutamide maintenance in metastatic castration resistant prostate cancer (mCRPC) previously treated with novel hormonal agents (NHA) and non-progressive disease after subsequent treatment with a taxane. This study sought to assess whether an immediate switch to darolutamide after disease stabilization with taxane chemotherapy for patients with mCRPC and prior NHA treatment might improve radiographic progression-free survival (rPFS).

ESMO 2021: Health-Related Quality of Life (HRQoL), Pain and Safety Outcomes in the Phase III VISION Study of 177Lu-PSMA-617 in Patients with Metastatic Castration-Resistant Prostate Cancer

(UroToday.com) In this study, Dr. Karim Fizazi discussed the health-related quality of life (HRQoL) data from the VISION study of 177Lu-PSMA-617 (Lu-PSMA). While the results of the VISION study, published earlier this year, demonstrated a significant improvement in radiographic progression-free survival (rPFS) and overall survival (OS) for men with metastatic castration-resistant prostate cancer (mCRPC), this is the first report of the HRQoL data.1

ESMO 2021: Enhanced Androgen Signaling Inhibition: A Requirement in the Upfront Treatment of Advanced Hormone-Sensitive Prostate Cancer

(UroToday.com) In this presentation, Dr. Eleni Efstathiou, discussed two oral abstracts from the Presidential Symposium: 1) Abiraterone acetate plus prednisolone (AAP) with or without enzalutamide (ENZ) added to androgen deprivation therapy (ADT) compared to ADT alone for men with high-risk non-metastatic (M0) prostate cancer (PCa): Combined analysis from two comparisons in the STAMPEDE platform protocol (LBA4PR) and 2) A phase 3 trial with a 2x2 factorial design in men with de novo metastatic castration-sensitive prostate cancer: overall survival with abiraterone acetate plus prednisone in PEACE-1 (LBA5PR). Dr. Efstathiou focused on how these studies address two major unmet needs in prostate cancer: 1) effective therapeutic strategies for localized high-risk disease and 2) the added value of combinatorial strategies.