GU Cancer Highlights at the 2024 AUA Annual Meeting - David Penson
March 11, 2024
Sam Chang hosts David Penson to shed light on the anticipated AUA 2024 meeting in San Antonio, focusing on the fresh, innovative sessions designed to elevate clinical practice. Dr. Penson introduces the P2 program—Practice-changing, Paradigm-shifting Research—aimed at spotlighting pivotal new clinical trials. With an impressive submission of about 90 studies, the program is set to feature eight groundbreaking cancer studies, promising significant impacts on urological practice. Highlights include three innovative intravesical therapies for bladder cancer and several other studies addressing critical questions in prostate cancer management, such as the comparison of HIFU versus radical prostatectomy and the use of apalutamide with ADT post-prostatectomy. This year's AUA also expands its scope with the Learning Lab, a non-CME space for exploring trials in progress, offering previews of potential future practice-changers.
Biographies:
David Penson, MD, MPH, MMHC, Director of the Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, TN
Sam S. Chang, MD, MBA, Urologist, Vanderbilt University Medical Center, Nashville, TN
Biographies:
David Penson, MD, MPH, MMHC, Director of the Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, TN
Sam S. Chang, MD, MBA, Urologist, Vanderbilt University Medical Center, Nashville, TN
Read the Full Video Transcript
Sam Chang: Hi, my name is Sam Chang, and I am a urologist in Nashville, Tennessee, and I work under probably one of the best bosses in America, and he's with us today. He needs no introduction, but Dr. David Penson, the Chair of Urology at Vanderbilt, is also now the secretary of the AUA. He's been kind enough to spend some time with us focusing on some key new innovative programs and parts of the schedule of the AUA for 2024 in San Antonio, that hopefully will actually raise excitement, and will lead to maybe some practice changes from what I can tell from the title. David, if you could tell us some of the highlights that you and the folks at the AUA have put together and give us those highlights.
David Penson: Well, Sam, thanks for the kind words to begin with. Every day, I consider myself lucky to work with people like you and the rest of our partners. It's just a wonderful family that we have at Vanderbilt. And so, thank you for the kind words. The feeling is mutual.
You've been watching me work on this meeting now for a year, and I'm really excited about it, and I'm particularly excited about the cancer sessions at the AUA. I think it's going to be terrific. There are a lot of great panels and presentations that people have come to expect at the AUA, but also a couple of new programs I really want to highlight. And so, why don't we start with the new stuff first, and then we can go back to the plenary session?
As secretary, each secretary gets to put his or her imprint on the meeting. And for me, I think it's really important that we raise the profile of clinical trials in urology because really that's what makes us change our practice. And so, we introduced a new program this year called the P2 program, which stands for Practice-changing, Paradigm-shifting Research. We sunsetted the late-breaking abstracts, and I asked urologists, and industry partners, and people who have anything to do with urology to submit new randomized clinical trials, which are going to report out, that are going to change the way we practice, which are going to shift the paradigms. I really stressed to people that I really wanted stuff that was truly going to make a difference.
And we ended up getting some really terrific abstracts. We actually had about 90 submissions, which was incredible to me, both benign and malignant. And in the end, we ended up choosing roughly eight studies in cancer, which I think are really going to make a big difference. Each of these studies is going to be presented at the AUA. It's the first time they've been presented. Each of these is going to, I think, have a major impact on the way we practice.
Let's talk about some of these studies, and you know some of them. There are three studies which have to do with intravesical therapy and bladder cancer. SunRISe-1, which is the TAR-200 product in BCG unresponsive patients. The BOND-003 study, which is a single-arm study of intravesical cretostimogene. It's an adenovirus, right?
Sam Chang: Yeah. Cretostimogene, people have shortened it. Some people are now just calling it creto, but cretostimogene.
David Penson: Yeah, you know, I did pretty well there. The third one is results from a Phase 1/2 study called The LEGEND study, which is [inaudible 00:03:34], which is a nonviral intravesical chemotherapy. They're all looking at the same patients. All of these products are on their way to FDA approval or certainly in the pipeline, and all of these are going to change the way we practice. I'm really excited about those three studies. They're going to go on Friday morning, and I think people are going to want to hear these results.
We're going to get an update from Seth Lerner from the SWOG study, looking at standard versus extended lymphadenectomy. Last year, they presented that at big ASCO. Now, they're going to do some subgroup analysis to see if perhaps one of the subgroups actually makes a difference.
Then we've got some great studies in prostate cancer, a bunch on imaging, and one on PSMA PET and MRI in the primary staging of prostate cancer. Another trial looking at lutetium versus ARPIs in taxane-naive patients with metastatic disease. And we have a couple of studies for patients who are undergoing prostatectomy. There's one called the HiFi trial, which is HIFU versus radical prostatectomy for localized prostate cancer, 3,328 cases. That's going to be fascinating because there's so much talk about HIFU and ablative therapies. Does it compare to surgery? Hopefully, that study is going to give us an answer, and that'll change the way we practice.
And last, but certainly not least, a randomized clinical trial looking at apalutamide and ADT for the treatment of high-risk localized prostate cancer after radical prostatectomy. This is a multicenter single-arm study. And again, if it's positive, we're going to change the way we practice. We're going to start giving these drugs. I'm really, really excited about these P2s.
That's in addition to other stuff going on in the plenary. It'll be in the big plenary room. We're going to have a long session in the afternoon on artificial intelligence in urology and specifically, urologic oncology. We're going to have a presentation of the new AUA guidelines for salvage therapy after prostatectomy. That's all in addition to the usual great sessions that we have. I'm really excited about that particular program.
Sam Chang: David, in addition, I think there's been an add-on or an evaluation of trials in progress as well, which is something that people like to know, "Hey, what's out there?" We get asked all the time by patients, "Well, what's being studied? What looks exciting?" Etcetera. The trials in progress, it seems like, are also promising studies that are starting to enroll or will soon be enrolling. Is that right?
David Penson: That's correct, yeah. On Sunday, we're going to have a new area of the meeting called the learning lab. And the learning lab is going to be off the science and technology hall, not in it, but right next to it, and it's a non-CME space. And the reason that we did it this way was because many of these studies are being sponsored by industry, and I wanted to make sure that the industry folks were able to be there and participate in the discussions. Because what I really want to do is I want urologists to know what's coming down the pike. This is almost a preview of what's going to be at next year's meeting, and the year after that, and so on and so forth. These are the sort of studies that I think when they report out again, are going to be really important studies.
And so, you have all of the Sunrise trials are going to be presented there, and the Moonrise trial. Those are the trials again, of the TAR product, the pretzel with various agents for bladder cancer. We're going to see another one of the Bond studies presented and discussed there. There are some other interesting studies coming down the pike that we're going to present there. Looking at an IL-15 superagonist in patients with bladder cancer, the QUILT-2.005. Now, none of these studies are done, but they're accruing or they're finished accruing and they're in follow-up. People can attend and actually ask the PIs questions, can ask the sponsors questions, what to expect, how it's going to change practice, when it's going to report out? And that's just a few of the many studies that we're going to see there.
We have several studies that are not industry-sponsored. For example, we have a study coming from the University of Washington on pre-rehabilitation around cystectomy. And another great study looking at VTE prevention after radical cystectomy from Kara Michel at the University of Pennsylvania. I'm excited about those.
And then after that, we've got a slew of studies around prostate cancer, and the same sort of topics. Things that are going to, when they report out, make a big difference. For example, we have a study comparing the TULSA procedure to radical prostatectomy that's ongoing, the CAPTAIN study. They're going to discuss that in clinical trials in progress.
Ted Shafer is going to talk about his study looking at TP biopsy versus transrectal biopsy, and now they're looking at whether or not you need antibiotics. A question study about prostate cancer screening from Dan Lin and the Canary Group. A study that Sia Daneshmand is going to present on testicular cancer. This is an opportunity to talk to these people about how the studies were designed, how they're accruing, and importantly when the results come out, how it's going to change practice.
My hope is that people are going to show up and see this in the clinical trials in progress and two, three years, they're going to see it in the P2 sessions in the big room at the plenary.
Sam Chang: Well, this is fantastic. We've got new changes, in terms of the innovation hall lab next to the science and technology area. We've got the practice-changing, the P2 changing, new paradigm setup, and that's in the plenary session, David, and that's going to be on Friday at the AUA, so the first day starting with a bang.
Clearly, the buzz around the in-person meetings continues to increase as people are looking forward to gathering and sharing information. But I can tell you from talking to you, that these new sessions within the AUA, the standards are there. The ones that we've always had, the updates at the end of the meeting on Monday, that's still there. But the ability to have actually these new highlighted areas where it really will impact how individuals will treat patients and how patients will get access to new trials or new drugs is really a big change. And to have that presented at our national meeting, I think, is really exciting.
David Penson: Yeah, it's going to be great. You mentioned the take-home messages, and I probably should have mentioned that too. I totally forgot about that. We're going to change the format a little bit for the cancer take-home messages, and we're going to have a discussion between a senior urologist and a junior urologist about the most important topics, the papers that they saw at the meeting, and that's going to be memorialized so people can watch that going forward. A little bit more interactive because I don't like being lectured to, although I can lecture with the best of them, as you know. But what you really want to do is you want to hear people talking and hear how they think. That's how you learn.
I know you won't let me say this, but I'm going to say it anyways. On Saturday morning before the SUO meeting, we're going to have "When Disaster Strikes," which is a panel, that's one of the most popular panels that we have at the meeting every year, where people go over tough cases, and disasters in the OR, and how to dig yourself out of it. That session is really useful for surgeons because they learn how to deal with that disaster. We have a new MC this year, none other than Sam Chang, so I think it's going to be really great having you lead that session, Sam, and I really appreciate you doing that. I think it's going to be terrific.
Sam Chang: It'll be good. We're looking forward to it. We've got a variety of scenarios that we think are going to be commonly seen, a stone scenario, a female reconstructive sling situation, an intraoperative bleeding situation during nephrectomy, situations and occurrences that do happen in practices. And hopefully, we can help avoid them happening but if they do happen, the do's and don'ts, and things that can really be helpful in a difficult time. And we really have some great experts that will be open, honest. I'm really emphasizing we want to be informative, but we want to be entertaining as well. And so, we look forward to that. Thanks for that opportunity, David, and thanks for spending some time with us. I think we're all excited to see each other and attend the meeting in San Antonio this summer.
David Penson: Looking forward to it. Thank you, Sam.
Sam Chang: Hi, my name is Sam Chang, and I am a urologist in Nashville, Tennessee, and I work under probably one of the best bosses in America, and he's with us today. He needs no introduction, but Dr. David Penson, the Chair of Urology at Vanderbilt, is also now the secretary of the AUA. He's been kind enough to spend some time with us focusing on some key new innovative programs and parts of the schedule of the AUA for 2024 in San Antonio, that hopefully will actually raise excitement, and will lead to maybe some practice changes from what I can tell from the title. David, if you could tell us some of the highlights that you and the folks at the AUA have put together and give us those highlights.
David Penson: Well, Sam, thanks for the kind words to begin with. Every day, I consider myself lucky to work with people like you and the rest of our partners. It's just a wonderful family that we have at Vanderbilt. And so, thank you for the kind words. The feeling is mutual.
You've been watching me work on this meeting now for a year, and I'm really excited about it, and I'm particularly excited about the cancer sessions at the AUA. I think it's going to be terrific. There are a lot of great panels and presentations that people have come to expect at the AUA, but also a couple of new programs I really want to highlight. And so, why don't we start with the new stuff first, and then we can go back to the plenary session?
As secretary, each secretary gets to put his or her imprint on the meeting. And for me, I think it's really important that we raise the profile of clinical trials in urology because really that's what makes us change our practice. And so, we introduced a new program this year called the P2 program, which stands for Practice-changing, Paradigm-shifting Research. We sunsetted the late-breaking abstracts, and I asked urologists, and industry partners, and people who have anything to do with urology to submit new randomized clinical trials, which are going to report out, that are going to change the way we practice, which are going to shift the paradigms. I really stressed to people that I really wanted stuff that was truly going to make a difference.
And we ended up getting some really terrific abstracts. We actually had about 90 submissions, which was incredible to me, both benign and malignant. And in the end, we ended up choosing roughly eight studies in cancer, which I think are really going to make a big difference. Each of these studies is going to be presented at the AUA. It's the first time they've been presented. Each of these is going to, I think, have a major impact on the way we practice.
Let's talk about some of these studies, and you know some of them. There are three studies which have to do with intravesical therapy and bladder cancer. SunRISe-1, which is the TAR-200 product in BCG unresponsive patients. The BOND-003 study, which is a single-arm study of intravesical cretostimogene. It's an adenovirus, right?
Sam Chang: Yeah. Cretostimogene, people have shortened it. Some people are now just calling it creto, but cretostimogene.
David Penson: Yeah, you know, I did pretty well there. The third one is results from a Phase 1/2 study called The LEGEND study, which is [inaudible 00:03:34], which is a nonviral intravesical chemotherapy. They're all looking at the same patients. All of these products are on their way to FDA approval or certainly in the pipeline, and all of these are going to change the way we practice. I'm really excited about those three studies. They're going to go on Friday morning, and I think people are going to want to hear these results.
We're going to get an update from Seth Lerner from the SWOG study, looking at standard versus extended lymphadenectomy. Last year, they presented that at big ASCO. Now, they're going to do some subgroup analysis to see if perhaps one of the subgroups actually makes a difference.
Then we've got some great studies in prostate cancer, a bunch on imaging, and one on PSMA PET and MRI in the primary staging of prostate cancer. Another trial looking at lutetium versus ARPIs in taxane-naive patients with metastatic disease. And we have a couple of studies for patients who are undergoing prostatectomy. There's one called the HiFi trial, which is HIFU versus radical prostatectomy for localized prostate cancer, 3,328 cases. That's going to be fascinating because there's so much talk about HIFU and ablative therapies. Does it compare to surgery? Hopefully, that study is going to give us an answer, and that'll change the way we practice.
And last, but certainly not least, a randomized clinical trial looking at apalutamide and ADT for the treatment of high-risk localized prostate cancer after radical prostatectomy. This is a multicenter single-arm study. And again, if it's positive, we're going to change the way we practice. We're going to start giving these drugs. I'm really, really excited about these P2s.
That's in addition to other stuff going on in the plenary. It'll be in the big plenary room. We're going to have a long session in the afternoon on artificial intelligence in urology and specifically, urologic oncology. We're going to have a presentation of the new AUA guidelines for salvage therapy after prostatectomy. That's all in addition to the usual great sessions that we have. I'm really excited about that particular program.
Sam Chang: David, in addition, I think there's been an add-on or an evaluation of trials in progress as well, which is something that people like to know, "Hey, what's out there?" We get asked all the time by patients, "Well, what's being studied? What looks exciting?" Etcetera. The trials in progress, it seems like, are also promising studies that are starting to enroll or will soon be enrolling. Is that right?
David Penson: That's correct, yeah. On Sunday, we're going to have a new area of the meeting called the learning lab. And the learning lab is going to be off the science and technology hall, not in it, but right next to it, and it's a non-CME space. And the reason that we did it this way was because many of these studies are being sponsored by industry, and I wanted to make sure that the industry folks were able to be there and participate in the discussions. Because what I really want to do is I want urologists to know what's coming down the pike. This is almost a preview of what's going to be at next year's meeting, and the year after that, and so on and so forth. These are the sort of studies that I think when they report out again, are going to be really important studies.
And so, you have all of the Sunrise trials are going to be presented there, and the Moonrise trial. Those are the trials again, of the TAR product, the pretzel with various agents for bladder cancer. We're going to see another one of the Bond studies presented and discussed there. There are some other interesting studies coming down the pike that we're going to present there. Looking at an IL-15 superagonist in patients with bladder cancer, the QUILT-2.005. Now, none of these studies are done, but they're accruing or they're finished accruing and they're in follow-up. People can attend and actually ask the PIs questions, can ask the sponsors questions, what to expect, how it's going to change practice, when it's going to report out? And that's just a few of the many studies that we're going to see there.
We have several studies that are not industry-sponsored. For example, we have a study coming from the University of Washington on pre-rehabilitation around cystectomy. And another great study looking at VTE prevention after radical cystectomy from Kara Michel at the University of Pennsylvania. I'm excited about those.
And then after that, we've got a slew of studies around prostate cancer, and the same sort of topics. Things that are going to, when they report out, make a big difference. For example, we have a study comparing the TULSA procedure to radical prostatectomy that's ongoing, the CAPTAIN study. They're going to discuss that in clinical trials in progress.
Ted Shafer is going to talk about his study looking at TP biopsy versus transrectal biopsy, and now they're looking at whether or not you need antibiotics. A question study about prostate cancer screening from Dan Lin and the Canary Group. A study that Sia Daneshmand is going to present on testicular cancer. This is an opportunity to talk to these people about how the studies were designed, how they're accruing, and importantly when the results come out, how it's going to change practice.
My hope is that people are going to show up and see this in the clinical trials in progress and two, three years, they're going to see it in the P2 sessions in the big room at the plenary.
Sam Chang: Well, this is fantastic. We've got new changes, in terms of the innovation hall lab next to the science and technology area. We've got the practice-changing, the P2 changing, new paradigm setup, and that's in the plenary session, David, and that's going to be on Friday at the AUA, so the first day starting with a bang.
Clearly, the buzz around the in-person meetings continues to increase as people are looking forward to gathering and sharing information. But I can tell you from talking to you, that these new sessions within the AUA, the standards are there. The ones that we've always had, the updates at the end of the meeting on Monday, that's still there. But the ability to have actually these new highlighted areas where it really will impact how individuals will treat patients and how patients will get access to new trials or new drugs is really a big change. And to have that presented at our national meeting, I think, is really exciting.
David Penson: Yeah, it's going to be great. You mentioned the take-home messages, and I probably should have mentioned that too. I totally forgot about that. We're going to change the format a little bit for the cancer take-home messages, and we're going to have a discussion between a senior urologist and a junior urologist about the most important topics, the papers that they saw at the meeting, and that's going to be memorialized so people can watch that going forward. A little bit more interactive because I don't like being lectured to, although I can lecture with the best of them, as you know. But what you really want to do is you want to hear people talking and hear how they think. That's how you learn.
I know you won't let me say this, but I'm going to say it anyways. On Saturday morning before the SUO meeting, we're going to have "When Disaster Strikes," which is a panel, that's one of the most popular panels that we have at the meeting every year, where people go over tough cases, and disasters in the OR, and how to dig yourself out of it. That session is really useful for surgeons because they learn how to deal with that disaster. We have a new MC this year, none other than Sam Chang, so I think it's going to be really great having you lead that session, Sam, and I really appreciate you doing that. I think it's going to be terrific.
Sam Chang: It'll be good. We're looking forward to it. We've got a variety of scenarios that we think are going to be commonly seen, a stone scenario, a female reconstructive sling situation, an intraoperative bleeding situation during nephrectomy, situations and occurrences that do happen in practices. And hopefully, we can help avoid them happening but if they do happen, the do's and don'ts, and things that can really be helpful in a difficult time. And we really have some great experts that will be open, honest. I'm really emphasizing we want to be informative, but we want to be entertaining as well. And so, we look forward to that. Thanks for that opportunity, David, and thanks for spending some time with us. I think we're all excited to see each other and attend the meeting in San Antonio this summer.
David Penson: Looking forward to it. Thank you, Sam.