ASCO GU 2021

ASCO GU 2021: Atezolizumab Monotherapy vs Chemotherapy in Previously Untreated Locally Advanced or Metastatic Urothelial Carcinoma: Clinical Outcomes by PD-L1 Status In Cisplatin-Ineligible Patients From the Phase III IMvigor130 Study

(UroToday.com) Atezolizumab (anti–PD-L1) monotherapy is approved for cisplatin-ineligible patients who have locally advanced or metastatic urothelial carcinoma with PD-L1–expressing immune cells on ≥ 5% of the tumor area (IC2/3 per VENTANA SP142 IHC assay).¹ The IMvigor130 primary analysis demonstrated a significant progression free survival benefit with atezolizumab plus platinum/gemcitabine (Arm A) versus placebo platinum/gemcitabine (Arm C) as first-line treatment formetastatic urothelial carcinoma.². At that time, interim overall survival data for Arm A versus Arm C were encouraging but immature. Overall survival with atezolizumab monotherapy (Arm B) could not be formally tested, but favorable efficacy was seen in IC2/3 patients. At the 2021 American Society of Clinical Oncology Genitourinary Cancers Symposium (ASCO GU), Dr. Matthew Galsky and colleagues presented results of their exploratory analysis of IMvigor130 assessing outcomes by PD-L1 status in cisplatin-ineligible patients.

ASCO GU 2021: Beyond the Basics: Harnessing the Immune System to Fight Prostate Cancer

(UroToday.com) In plenary presentation in the Progress and Promise in Treatment Personalization for Advanced Prostate Cancer session at the 2021 American Society of Clinical Oncology Genitourinary Cancers Symposium (ASCO GU), Dr. Karen Autio discussed ways in which we can harness the immune system to treat prostate cancer, emphasizing the role of immune checkpoint inhibitors in prostate cancer.

ASCO GU 2021: Optimal Therapy for BCG-Unresponsive Non-Muscle-Invasive Bladder Cancer in the Non-cystectomy Candidate - Intravesical

(UroToday.com) At the 2021 American Society of Clinical Oncology Genitourinary Cancers Symposium (ASCO GU) session on optimizing personalized management of non-muscle invasive bladder cancer included a debate regarding the optimal therapy for BCG-unresponsive disease among patients that are not cystectomy candidates. Dr. Peter Black from Vancouver, British Columbia made the argument for intravesical therapy as the optimal treatment.

ASCO GU 2021: The von Hippel-Lindau Tumor Suppressor Protein: Rosetta Stone for Kidney Cancer Pathogenesis and Treatment

(UroToday.com) At the 2021 American Society of Clinical Oncology Genitourinary Cancers Symposium (ASCO GU) Dr. Kaelin provided the keynote lecture entitled “von Hippel-Lindau Tumor Suppressor Protein: Rosetta Stone for Kidney Cancer Pathogenesis and Treatment”.

ASCO GU 2021: Clinically Significant Events Associated with Metastatic Castration-Resistant Prostate Cancer (mCRPC) Treatments

(UroToday.com) Real-world data regarding treatment patterns for metastatic castration-resistant prostate cancer (mCRPC) remain scarce due to the lack of a specific ICD-10 code for these patients. Using the Optum Research Database, which includes enrollment information and medical/pharmacy claims for over 73 million enrollees with commercial coverage and 8.3 million enrollees with Medicare, the authors created a specific algorithm to identify patients with mCRPC with claims between 2008 and 2019. Criteria for identifying mCRPC patients included (1) more than one claim for prostate cancer, (2) one or more claims for pharmacologic or surgical castration, (3) metastatic disease, and (4) more than six months of continuous enrollment before and after the first metastatic disease claim. The authors then explored the association between clinically significant events (CSEs) and mCRPC treatment. CSEs were assessed during the first line of therapy that was used for mCRPC. To assess rates of clinically significant events (CSEs) on therapy, time on treatment was used as the denominator to control for different durations of treatment.

ASCO GU 2021: Clinical Conundrums of Genomically Driven Prostate Cancer - Case Panel Discussion

(UroToday.com) The case presented was that of a 54-year-old man with an extensive family history of cancer. His mother died from ovarian cancer, his father had prostate cancer and died of colon cancer, his brother developed kidney and prostate cancer, and his sister had breast and ovarian cancer. The patient had germline testing, which revealed a heterozygous BRCA1 c.1961delA known pathogenic frameshift mutation that leads to a truncated or absent protein. The patient’s medical history was also notable for a pT1 seminoma treated with orchiectomy and radiotherapy (likely unrelated to the BRCA1 alteration) and a recent squamous cell of unknown primary in an inguinal node that was detected during his prostate cancer workup. This was treated with radiotherapy and concurrent 5FU/cisplatin.

ASCO GU 2021: Phase IIb Trial of Oral ModraDoc006/ritonavir as a Tolerable and Effective Option in Comparison with Intravenous Docetaxel in mCRPC

(UroToday.com) ModraDoc006 is a novel, oral tablet formulation of docetaxel. To enhance bioavailability, it is co-administered with ritonavir (r), an inhibitor of cytochrome P450 3A4 and P-glycoprotein. The oral combination, noted as ModraDoc006/r, has potential advantages in terms of patient convenience, elimination of infusion-related reactions, and avoiding prophylactic steroid administration, as well as safety benefits. At the GU ASCO 2021 annual meeting, Dr. Ulka Vaishampayan and colleagues presented efficacy results of the Phase IIb trial comparing oral ModraDoc006/r to IV docetaxel.

ASCO GU 2021: Beyond the Basics: Harnessing the Immune System to Fight Prostate Cancer

(UroToday.com) In this session, Dr. Karen Autio discussed the indications for immune checkpoint inhibitors in prostate cancer, what is known about the tumor immune milieu in prostate cancer, and discussed ongoing work to further harness the immune system in the fight against this disease.

ASCO GU 2021: Back to Basics in Personalization: Returning to PTEN

(UroToday.com) In this session, Martin Gleave discusses alteration in the PI3K signaling pathway as an important molecular subtype of metastatic castration-resistant prostate cancer. Alterations in PI3K signaling contribute to the pathogenesis of many cancers. PTEN, a tumor suppressor that opposes the action of PI3K by converting PIP3 back to PIP2, is frequently lost in prostate cancer. PTEN loss is strongly linked to prostate carcinogenesis, disease progression, treatment resistance, and overall poor clinical outcomes. The mechanisms leading to loss of PTEN expression are cancer-specific, and different cancers harbor other various mechanisms of increased PI3K signaling, including PIK3CA mutations and AKT activating mutations. Upwards of 40% of mCRPC harbor genomic disruption of PTEN, most commonly homozygous deletion.

ASCO GU 2021: Association of Co-Occurring Gene Alterations and Clinical Activity of Rucaparib in Patients with BRCA1 or BRCA2 Mutated (BRCA+) Metastatic Castration-Resistant Prostate Cancer (mCRPC)

(UroToday.com) The TRITON2 study led to the approval of the PARP inhibitor rucaparib in patients with BRCA-mutated mCRPC that has progressed on prior androgen receptor signaling inhibition and one taxane chemotherapy. While response rates to rucaparib in different subgroups (germline vs. somatic, type of alteration) were similar, it is unknown how other co-occurring mutations, especially those that confer poor prognoses like TP53, PTEN, or RB1, impact the efficacy of rucaparib.

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ASCO GU 2021

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