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ASCO GU 2021

ASCO GU 2021: Approaches to Immune Checkpoint Inhibitor Maintenance Therapy in Metastatic Urothelial Cancer: A Qualitative Analysis of Oncology Providers in the United States

(UroToday.com) There were approximately 81,400 new cases of bladder cancer diagnosed in 2020 and nearly 90% of these cases are urothelial carcinoma. Unresectable, locally advanced, or metastatic urothelial carcinoma is present in nearly 20% of all invasive urothelial carcinoma cases worldwide. Immune checkpoint inhibitors have demonstrated long-term responses with tolerable safety profiles in patients with metastatic urothelial carcinoma, including avelumab as first-line maintenance therapy for patients with advanced/metastatic urothelial carcinoma that have not progressed with platinum-containing chemotherapy. This treatment approach was recently approved in the US based on improved overall survival seen in the JAVELIN Bladder 100 trial.1 However, provider perspectives regarding first-line maintenance therapy in metastatic urothelial carcinoma have not been reported. At the GU ASCO 2021 annual meeting, Dr. Petros Grivas and colleagues presented results of their study of a quality analysis of oncology providers in the US with regards to their approaches to immune checkpoint inhibitor maintenance therapy for metastatic urothelial carcinoma.

ASCO GU 2021: PI3K/AKT Pathway Biomarkers Analysis from the Phase III IPATential150 Trial of Ipatasertib plus Abiraterone in Metastatic Castration-Resistant Prostate Cancer

(UroToday.com) In IPATential150 (NCT03072238), ipatasertib plus abiraterone as first-line treatment for metastatic castration-resistant prostate cancer (mCRPC) significantly reduced the risk for disease worsening or death versus placebo plus abiraterone in patients with tumors with PTEN loss by immunohistochemistry (HR 0.77, 95% CI 0.61-0.98) but not in the intention-to-treat population. In patients with PTEN loss tumors by immunohistochemistry, median radiographic progression-free survival was 16.5 months (95% CI 13.9-17.0) with placebo plus abiraterone and 18.5 months (95% CI 16.3-22.1) with ipatasertib plus abiraterone. At the GU ASCO 2021 annual meeting, Dr. Johann De Bono presented results of exploratory analyses evaluating putative biomarker associations with radiographic progression free survival.

ASCO GU 2021: Genomic Analysis of Circulating Tumor DNA in Patients with Advanced Prostate Cancer to Identify Targetable BRCA Alterations and AR Resistance Mechanisms

(UroToday.com) Comprehensive genomic profiling by next-generation sequencing of circulating tumor DNA (ctDNA) from plasma provides a minimally invasive method to identify targetable genomic alterations and resistance mechanisms in patients with metastatic castration-resistant prostate cancer (mCRPC). However, the circulating tumor fraction in patients with mCRPC and the clinical validity of genomic alterations detected in plasma remains unknown. At the 2021 American Society of Clinical Oncology Genitourinary Cancers Symposium (ASCO GU), Hanna Tukachinsky and colleagues presented the results of their study evaluating the landscape of genetic alterations using ctDNA-based comprehensive genomic profiling and assessed concordance with tissue-based comprehensive genomic profiling.

ASCO GU 2021: PSMA-Targeted Imaging With 18F-DCFPyL-PET in Patients With Biochemically Recurrent Prostate Cancer

(UroToday.com)Biochemical recurrence is a not infrequent occurrence following local therapy for prostate cancer, utilizing either radiotherapy or radical prostatectomy. Following biochemical relapse, patients may have disease either locally in the pelvic or more distantly. An understanding of the location and burden of recurrence disease is important in guiding subsequent therapies.

ASCO GU 2021: Androgen Deprivation Therapy and Risk of SARS-CoV-2 Infection in Men with Prostate Cancer: A University of California Health System Registry Study

(UroToday.com) SARS-CoV-2 entry into host lung cells is facilitated by the transmembrane protease TMPRSS2, which is expressed in both lung and prostate tissue. Pre-clinical data has suggested that TMPRSS2 expression can be modulated by the androgen receptor and that androgen deprivation therapy may protect patients from SARS-CoV-2 infection and decrease the severity of COVID-19.

ASCO GU 2021: Prevalence of Microsatellite Instability and Monitoring Response to Immune Checkpoint Inhibition Utilizing Liquid Biopsy Among African American Men with Advanced Prostate Cancer

(UroToday.com) As the most common non-cutaneous cancer of men in the United States, prostate cancer affects the African-American population with higher incidence and higher prostate-cancer specific mortality than men, not of African ancestry. The reasons for the higher burden of disease and disparate outcomes have been attributed, in part, due to social, economic, environmental, and biological influences. The biological factors are still opaque, with retrospective data to suggest an improved response to certain therapies, including sipuleucel-T1, suggesting a possible difference in tumor-immune interaction. Rates of microsatellite instability (MSI)-high is low in prostate cancer overall, with a paucity of data in African-American prostate cancers specifically. The authors sought to indirectly evaluate potential response to immune checkpoint inhibition by measuring MSI using next-generation sequencing assays, Tempus xT (648-gene sequencing panel + whole-transcriptome RNAseq) and/or Tempus xF (105-gene targeted panel), on tissue or liquid compartment, respectively. 

ASCO GU 2021: Best of the Journals – Prostate Cancer: Medical Oncology

(UroToday.com) The 2021 GU ASCO annual meeting included a prostate cancer session ‘Best of the Journals’ with Dr. Hala Borno providing the medical oncology perspective. Dr. Borno provided the following diagram for which papers she was going to discuss based on prostate cancer disease state:

ASCO GU 2021: Use of Genomics to Guide Treatment Decisions in Post-Prostatectomy Patients

(UroToday.com) The 2021 American Society of Clinical Oncology (ASCO) Genitourinary (GU) Cancers Symposium included a presentation by Dr. Ashley Ross discussing the use of genomics to guide treatment decisions in post-prostatectomy patients. Dr. Ross notes that a recent systematic review assessed the clinical utility of the Decipher® genomic classifier recently published in European Urology.1 This genomic classifier assesses 22 genes representing multiple oncologic pathways, is heavily validated, and is independently prognostic of oncologic outcomes. In this systematic review, there were 42 studies and 30,407 patients included. In 32 studies (n=12,600), the genomic classifier was independently prognostic for all study endpoints (adverse pathology, biochemical failure, metastasis, and cancer-specific and overall survival) and improved the discrimination over standard of care in 24 studies (n=8,543):

ASCO GU 2021: Prospective Randomized Trial of Gene Expression Classifier Utility Following Radical Prostatectomy (G-MINOR)

(UroToday.com) Decipher is a tissue-based genomic classifier developed and validated in the post-radical prostatectomy setting as a predictor of metastasis.1 However, to date, there is no randomized controlled trial data assessing prostate cancer genomics. As such, Dr. Todd Morgan and the MUSIC collaborative group conducted the first prospective randomized controlled trial assessing the use of a prostate cancer genomic classifier, with a primary objective to determine the impact of test results on adjuvant treatment decisions. At the GU ASCO 2021 annual meeting, Dr. Morgan presented the results of this study in the rapid abstract session.

ASCO GU 2021: Randomized Phase II Trial of Radium-223 plus Enzalutamide Versus Enzalutamide Alone in mCRPC: Final Efficacy and Safety Results

(UroToday.com) The clinical benefit of radium-223 has been demonstrated in patients with metastatic castration resistant prostate cancer (mCRPC) in the ALSYMPCA randomized placebo controlled trial.1 Over the last nearly decade since publication of this landmark trial, combination therapy in patients with mCRPC is of great interest for improving efficacy but must be done in a safe manner for these patients. Agarwal et al. previously reported that treatment with enzalutamide plus Radium-223 was associated with a decline in serum bone metabolism markers, which correlated with improved outcomes compared to enzalutamide alone.2 At the GU ASCO 2021 annual meeting, medical student Adam Kessel and colleagues presented results of the final efficacy and safety results for this trial.
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