ASCO GU 2018

ASCO GU 2018: Erdafitinib, (FGFR) a Pan-fibroblast Growth Factor Receptor Inhibitor, in Patients with Metastatic or Unresectable Urothelial Carcinoma and FGFR Alterations

San Francisco, CA (UroToday.com) Although immune checkpoint inhibitors (ICI) have improved outcomes in some patients with platinum-resistant metastatic or unresectable urothelial carcinoma (mUC), many patients (eg, patients with TCGA luminal 1 tumors, many of whom are FGFR alterations (FGFRa)) may not benefit. Erdafitinib (ERDA; JNJ-42756493), a pan-fibroblast growth factor receptor (pan-FGFR) (1-4) inhibitor, demonstrated promising phase 1 activity: 11 partial responses among 24 FGFRa mUC pts. We report efficacy and safety of ERDA in the ongoing global open-label phase 2 study BLC2001 (NCT02365597).

ASCO GU 2018: Phase II Trial of 6 Months ADT/Abiraterone Acetate Plus Prednisone and Definitive Radiotherapy - Intermediate to High Risk Localized Prostate Cancer - AbiRT Trial

San Francisco, CA (UroToday.com) Combined external beam radiotherapy (RT) and androgen deprivation therapy (ADT) improves survival over RT alone for high risk prostate cancer (PC). Long-term ADT use, currently recommended for high risk PC, also increases toxicity. Recent data suggests synergistic efficacy with the addition of abiraterone acetate plus prednisone (AAP) to RT/ADT. Potent androgen blockade may provide biochemical control with short-term ADT course in men with aggressive but localized PC.

ASCO GU 2018: Expression of Immune Checkpoints on Circulating Tumor Cells in Men with Metastatic Prostate Cancer 

San Francisco, CA (UroToday.com) Most immune checkpoint inhibitors have shown limited efficacy in unselected men with mPC, and there is limited understanding about which immune checkpoints (ICs) are relevant in mPC. We evaluated ICs on the cell surface of circulating tumor cells (CTCs) in patients with mPC.

ASCO GU 2018: Clinical Utility of Foundation One Tissue Molecular Profiling in Men with Metastatic Prostate Cancer

San Francisco, CA (UroToday.com) In the era of precision medicine, significant effort has been placed on identifying clinically actionable molecular targets to aid in the treatment of metastatic prostate cancer (mPC). Recent data supports homologous repair and mismatch repair deficiencies to guide the use of PARP inhibitors/platinum chemotherapy or pembrolizumab, respectively. We analyzed the clinical utility of Foundation One (FO) somatic genomic profiling in men with mPC.

ASCO GU 2018: Patterns of Progression in Bone and Soft Tissue Following Treatment with Ra-223 in Metastatic Castrate Resistant Prostate Cancer

San Francisco, CA (UroToday.com) Bone scans were not obtained in the phase 3 ALSYMPCA trial, and retrospective series have reported varying rates of development of new lesions and resolution of existing lesions, following treatment with Radium-223 (Ra-223).

ASCO GU 2018: The CLEAR study: A Phase 3 Trial to Compare Efficacy and Safety of Lenvatinib in Combination with Everolimus or Pembrolizumab Versus Sunitinib Alone in First-line Treatment of Patients with Metastatic Renal Cell Carcinoma

San Francisco, CA (UroToday.com) Lenvatinib (LEN) is a multikinase inhibitor of vascular endothelial growth factor (VEGF) receptor 1–3, fibroblast growth factor receptor 1–4, platelet-derived growth factor receptor alpha, and RET and KIT. Based on a phase 2 study,1 LEN was approved in combination with everolimus (EVE) for the treatment of metastatic renal cell carcinoma (RCC) following 1 prior VEGF-targeted therapy. A phase 1b/2 study of LEN in combination with pembrolizumab (PEM) in patients (pts) with RCC is also underway.

ASCO GU 2018: Self-reported Quality of Life as a Predictor of Survival in Renal Cell Carcinoma

San Francisco, CA (UroToday.com) While biomarkers for various malignancies continue to be developed, sometimes there can be no substitute for a physical and mental exam. Clinical evaluation of the patient may provide guidance into their cancer-related status and perhaps even serve as a biomarker.

ASCO GU 2018: Treatment Facility Volume and Survival in Patients with metastatic Renal Cell Carcinoma

San Francisco, CA (UroToday.com) Prognosis of metastatic renal cell carcinoma (mRCC) has significantly improved in the targeted therapy era. Novel therapies continue to be developed for mRCC, making the management much more nuanced.

ASCO GU 2018: Carcinomas of the Renal Medulla: A Comprehensive Genomic Profiling Study

San Francisco, CA (UroToday.com) Collecting duct carcinoma (CDC) and renal medullary carcinoma (RMC) represent rare renal tumors that arise in the renal medulla, resistant to therapy, and progress rapidly.

ASCO GU 2018: Association of Dividing Pathologically Upstaged T3a Renal Cell Carcinoma with Improved Alignment of Outcomes: A Call for TMN Revision

San Francisco, CA (UroToday.com) Incidental pathological upstaging to pT3a disease can occur after surgical treatment of clinical T1 and T2 Renal Cell Carcinoma (RCC), and upstaged pT3a disease is associated with worsened outcomes. Oncologic and survival outcomes within the pT3a category are heterogeneous. The authors investigated recurrence and survival outcomes in pT3a disease, and aimed to better categorize this cohort for improvement on current TMN staging.

ASCO GU 2018: A Phase III Randomized Study Comparing Perioperative Nivolumab vs. Observation in Patients with Localized Renal Cell Carcinoma Undergoing Nephrectomy

San Francisco, CA (UroToday.com) The anti-PD-1 antibody nivolumab (nivo) improves overall survival (OS) in metastatic treatment refractory RCC and is generally tolerable. In 2017, there is no standard adjuvant therapy proven to increase OS over surgery alone in non-metastatic (M0) disease. Mouse solid tumor models have revealed an OS benefit with a short course of neoadjuvant PD-1 blockade compared to adjuvant therapy.

ASCO GU 2018: Treatment trends of localized renal cell carcinoma by hospital type: A NCDB analysis

San Francisco, CA (UroToday.com) Accounting for operative, oncologic and comorbid risks guide treatment recommendations for localized kidney cancers. The authors hypothesized that individualized surgical decision making may also be influenced by surgical center and volume.

ASCO GU 2018: Effects of Patient Gender on Urologist Decision-Making Regarding Treatment of the Localized Renal Mass Introduction and Objective

San Francisco, CA (UroToday.com) Gender disparity in the proportion of patients receiving nephron sparing strategies (NSS) for the treatment of localized renal masses has been demonstrated in large population series as well as in single centers of excellence. However, the reasons for the gender discrepancy remains elusive. The authors aimed to assess urologist treatment patterns for localized renal masses in both genders to gauge the existence of provider-based gender biases. It was hypothesized that female patients may be recommended more aggressive treatment due to provider biases related to patient gender.

ASCO GU 2018: Systemic Immune Inflammation Index and Treatment Response in Patients with Metastatic Renal Cell Cancer

San Francisco, CA (UroToday.com) Biomarkers to predict response are highly sought after, as they can help reduce overtreatment and help prevent delay to appropriate treatment. Inflammatory markers have been assessed in multiple malignancies. In this smaller institutional series, the authors investigate the prognostic value of the pretreatment inflammatory characteristics on treatment response and survival in patients with metastatic renal cell carcinoma (mRCC). It was a study of 149 patients, and was completed as a retrospective study.

ASCO GU 2018: Does Treatment Approach for Small Renal Masses Affect Survival in Patients 70 Years Old?

San Francisco, CA (UroToday.com) With the advent of modern imaging techniques, small renal masses are being diagnosed more frequently. Many of these masses are benign, and those that are malignant are often low grade and rarely affect survival. Surveillance is more commonly being advocated as an option for these masses. This study elucidates survival following different treatment approaches.

ASCO GU 2018: Outcomes and Patterns of Disease Progression in Metastatic Renal Cell Carcinoma Patients Treated with Nivolumab

San Francisco, CA (UroToday.com) 
Background:
Nivolumab (nivo) has been approved for the treatment of refractory metastatic renal cell carcinoma (mRCC). Data regarding the characteristics and outcomes of patients who progress on nivo are lacking.

ASCO GU 2018: The Impact of Facility Case Volume on Overall Survival in Patients with Metastatic Renal Cell Carcinoma in The Targeted Therapy Era

San Francisco, CA (UroToday.com) Prognosis of metastatic renal cell carcinoma (mRCC) has significantly improved in the targeted therapy era. Novel therapies continue to be developed for mRCC, making the management much more nuanced.

ASCO GU 2018: Impact of Intravenous Acetaminophen on Outcomes following Radical Nephrectomy

San Francisco, CA (UroToday.com) 
Background:
Intravenous acetaminophen (IVA) was approved for use in the US for moderate to severe pain in 2010. The role of postoperative IVA following radical nephrectomy (RN) is of particular interest given the potential nephrotoxic and bleeding risks associated with other non-opioid alternatives, such as parenteral non-steroidal anti-inflammatory drugs. However, given the relatively high cost of IVA versus other pain medications, the benefit of IVA in the postoperative period is unclear. Therefore, the authors sought to determine if the use of postoperative IVA is associated with improved outcomes following RN.

ASCO GU 2018: Defining Individual Recurrence Risk Following Surgery for High Risk Non-Metastatic Renal Cell Carcinoma

San Francisco, CA (UroToday.com) Current models to estimate renal cell carcinoma (RCC) recurrence risk following surgery are derived from populations containing primarily low-risk patients. The objective of this study was to evaluate risk factors for recurrence among high risk non-metastatic RCC patients following attempted curative surgery.

ASCO GU 2018: Utilization and Survival Implications of a Delayed Approach to Targeted Therapy for Metastatic Renal Cell Carcinoma: A Nationwide Cancer Registry Study

San Francisco, CA (UroToday.com) Targeted therapy (TT) is the first-line option for metastatic renal cell carcinoma (mRCC). While it does provide survival benefit, it is not curative, and all patients eventually progress. It is associated with a high-cost and has known, sometimes significant, adverse events.
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