2016 Genitourinary Cancers Symposium

Dr Apolo talks to ecancerv at ASCO GU 2016 about the use of avelumab (MSB0010718C) for metastatic urothelial carcinoma (mUC). Avelumab is a fully human anti-PD-L1 IgG1 antibody being investigated in multiple clinical trials. This study reported the safety and clinical activity of avelumab as a second-line therapy in patients with metastatic urothelial carcinoma based on level of PD-L1 expression. Avelumab showed an acceptable safety profile and had clinical activity in patients with mUC. There was a trend towards higher overall response rate and prolonged progression free survival rate at 12 weeks in patients with PD-L1 mUC. Further analyses of PD-L1 expression and clinical activity of avelumab in urothelial carcinoma are ongoing.

Dr Escudier talks to ecancertv at ASCO GU 2016 about how patients with advanced kidney cancer live for nearly twice as long without their disease progressing if they are treated with cabozantinib, a small molecule tyrosine kinase inhibitor (TKI) that targets c-MET, VEGFR2 and AXL. In the interview he discusses the results of the open-label METEOR trial, which compared the TKI against everolimus, a standard of care in mRCC. The METEOR trial met its primary endpoint of improved progression free survival, and subgroup analyses of the endpoints progression free survival and overall response rate generally favoured cabozantinib over everolimus in patients with advanced RCC.

Dr Bagrodia talks to ecancertv at ASCO GU 2016 about actionable targets in patients with cisplatin-resistant advanced germ cell tumours. Approximately 30% of patients with advanced germ cell tumour will progress after first-line chemotherapy. Nearly half of these patients will die of progressive germ cell tumours. Dr Bragrodia describes actionable alterations that may guide treatment selection in a significant proportion of patients with cisplatin-resistant advanced germ cell tumours. Targeted sequencing of these patients may allow enriched clinical trials in the future with patients whose tumours harbour alterations in the drug target of interest.

Dr Allard talks to ecancertv at ASCO GU 2016 about his work on a study which found that men who take aspirin regularly may have a lower risk of dying from prostate cancer. Men who took aspirin regularly after their prostate cancer diagnosis were less likely to die from the disease, however aspirin did not affect the overall incidence of prostate cancer.

Dr Baumann talks to ecancertv at ASCO GU 2016, about the work lead by his colleague Dr Mohamed S. Zaghloul Prof and Chairman Radiation Oncology Department, Children's Cancer Hospital & National Cancer Institute, Cairo University, Egypt. The team carried out a randomised clinical trial comparing adjuvant radiation, versus chemo-radiotherapy, versus chemotherapy alone after radical cystectomy for locally advanced bladder cancer. Dr Baumann discusses the growing interest in using adjuvant radiation therapy to reduce local failures after radical cystectomy for locally advanced bladder cancer. Radiotherapy was associated with significantly improved local control compared to chemotherapy alone, however there was no significant difference in disease free survival, distant metastasis-free survival, or overall survival.

Prof James (University of Warwick, Warwick, UK) and Prof Efstathiou (MD Anderson Cancer Center, Houston, USA) discuss survival results from the STAMPEDE randomised controlled trial for ecancertv at ASCO GU 2016. Celecoxib was investigated with or without zoledronic acid for hormone-naïve prostate cancer. The data showed no survival advantage for the addition of celecoxib alone for men starting long-term hormone therapy for the first time. However, the addition of celecoxib combined with zoledronic acid demonstrated a survival advantage for men with metastatic disease, in a pre-planned analysis, and requires further investigation.

Dr Shore (Carolina Urologic Research Center, Myrtle Beach, USA) and Dr Merseburger (University Hospital Schleswig-Holstein, Lübeck, Germany) discuss new treatment options for metastatic prostate cancer for ecancertv at ASCO GU 2016. They discuss an open-label phase II study which evaluated the efficacy of concurrent administration of radium Ra 223 dichloride (Ra-223) and abiraterone acetate (AA) in men with castration-resistant prostate cancer (CRPC) with symptomatic bone metastases. They also consider a new option arising for those CRPC patients who have become resistant to abiraterone and enzalutamide - the dual CYP17-Lyase (L) inhibitor / androgen receptor (AR) antagonist VT-464.

Dr McKay talks to ecancertv at ASCO GU 2016 about her research in to the impact of symptomatic skeletal events (SSE) in castration resistant prostate cancer (CRPC) patients. Prostate cancer patients frequently develop bone metastases, leading to symptomatic skeletal events. The study evaluated the impact of SSE on healthcare resource utilization, health-related quality of life, and pain. The economic and quality of life burden of SSE amongst CRPC patients with bone metastases is high, underscoring the need for preventive treatments for SSE in this population.

Dr McKay talks to ecancertv at ASCO GU 2016 about the impact of metformin on outcomes in patients with metastatic renal cell carcinoma (mRCC). The study is the largest study to date investigating the role of metformin on outcomes in metastatic renal cell carcinoma patients, using results from a pooled clinical trials database. The study demonstrated that concomitant use of metformin may improve survival in diabetic patients with mRCC treated with sunitinib. Based on preclinical data, Dr McKay hypothesises that the mechanism underlying this survival benefit may be related to synergistic inhibition of the MAPK pathway.

Dr Eleni Efstathiou (MD Anderson Cancer Center, Houston, USA) chairs a discussion with Dr Axel Merseburger (University Hospital Schleswig-Holstein, Lübeck, Germany), Prof Nick James (University of Warwick, Warwick, UK) and Prof Karim Fizazi (Institut Gustave Roussy, Paris, France) for ecancertv at ASCO GU 2016. The panel discuss the results from the CHHiP trial which compared hypofractionated high-dose intensity-modulated radiotherapy schedules. They also consider a phase III trial looking at the use of anti-androgen therapy with bicalutamide during and after salvage radiation therapy. They discuss the latest results from the STAMPEDE trial which looked at the use of celecoxib with or without zoledronic acid for hormone-naïve prostate cancer. Finally, they touch upon an early study that suggests that an experimental new blood test may help guide individualised decisions on the most appropriate treatments for patients with prostate cancer.

Dr Hoffman-Censits talks to ecancertv at ASCO GU 2016 about IMvigor 210, a phase II trial of atezolizumab (MPDL3280A) in platinum-treated locally advanced or metastatic urothelial carcinoma (mUc). Dr Hoffman-Censits discusses the poor overall response rate and survival of mUC patients who progress after platinum-based chemotherapy. The trial demonstrated significantly improved overall response rate when compared to historic controls. Responses were found to be durable and associated with higher PD-L1 IC expression while poor prognostic factors did not preclude response. Atezolizumab was well tolerated, and a randomized phase III study vs cetuximab is ongoing.

Dr Choueiri talks to ecancertv at the ASCO GU 2016, about a study looking at associations between analgesic use and risk of renal cell cancer overall and by subtypes, taking data from both the Nurses’ Health Study (NHS) and the Health Professionals Follow-up Study (HPFS). The findings support a significant positive association between non-aspirin NSAID use and risk of developing renal cell cancer, especially the lethal form.

Dr Necchi talks to ecancertv at ASCO GU 2016, about his work on an open-label, single-group, phase II study of brentuximab vedotin as salvage therapy for males with relapsed germ-cell tumours. The results showed that brentuximab has potent antitumour activity and meaningful immunomodulatory effects in germ-cell testicular tumours.

Dr Necchi talks to ecancertv at ASCO GU 2016, about results from a phase II study of the Aurora A kinase, tyrosine kinase inhibitor, alisertib (MLN8237) in patients with pretreated urothelial cancer. Preliminary data suggest the possibility for sustained disease control in about 20% of patients. Hb ≥ 10 and mutations of TSC1/mTOR might be the clinical and biological markers for patient enrichment design with inhibitors like alisertib, although the incidence of adverse events is a major concern.

Prof Pili talks to ecancertv at ASCO GU 2016, about the results from the phase II study CTEP#7870: treating renal cell carcinoma patients with entinostat and high-dose interleukin 2 (IL-2). Immunosuppressive factors such as regulatory T cells and myeloid-derived suppressive cells limit the efficacy of immunotherapies. Histone deacetylase (HDAC) inhibitors have been shown to have immunomodulatory effects which can be harnessed to improve treatment efficacy. The results from this phase I/II suggest that entinostat may increase the therapeutic effect of high dose IL-2 by modulating immunosuppressive cells.

Dr Choueiri talks to ecancertv at the ASCO GU 2016 meeting about updates in prostate and renal cancer presented at the meeting. Dr Choueiri discusses the recent data from the subgroup analyses of METEOR and the results from the CheckMate 025 phase III trial, as well as covering some updates in renal and testicular cancer.