POPULARITY
28 episodes with psma
25 episodes with psma
7 episodes with psma
7 episodes with psma
7 episodes with psma
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3 episodes with psma
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4 episodes with psma
In today's episode, filmed live at the 43rd Annual Chemotherapy Foundation Symposium, lung cancer expert Benjamin P. Levy, MD, hosted a cross-specialty discussion with genitourinary (GU) cancer expert Scott T. Tagawa, MD, MS, FACP, FASCO, about the rapidly evolving treatment paradigms for prostate and kidney cancer. Dr Levy is the clinical director of medical oncology at the Johns Hopkins Sidney Kimmel Cancer Center at Sibley Memorial Hospital and an associate professor of oncology at the Johns Hopkins University School of Medicine in Washington, DC. Dr Tagawa is a professor of medicine and urology at Weill Cornell Medicine, as well as an attending physician at NewYork-Presbyterian – Weill Cornell Medical Center in New York, New York. Their conversation began with a focus on prostate-specific membrane antigen (PSMA)–positive prostate cancer. Dr Tagawa explained that PSMA is a cell surface protein, and that PSMA imaging agents are commonly used to assess biochemical recurrence and perform initial disease staging. He noted that therapy-related adverse effects are often site-specific, including dry mouth/change in taste, and myelosuppression from the radiation payload. For monitoring long-term safety, Dr Tagawa emphasized that renal function must be tracked. Beyond PSMA, other prostate cancer targets include TROP-2, B7-H3, and markers specific to aggressive or neuroendocrine variants, such as DLL3, he reported. In advanced GU cancers, circulating tumor DNA (ctDNA) testing is increasingly important, Dr Tagawa highlighted. In prostate cancer, ctDNA testing is used to assess homologous recombination deficiency (HRD) status and BRCA expression, he said, explaining that evidence for the use of ctDNA testing in GU cancers stems from findings with this type of assay to evaluate minimal residual disease levels in urothelial cancer. He noted that studies show that if patients with urothelial cancer become ctDNA positive within the first year of receiving neoadjuvant chemotherapy, they benefit from treatment with atezolizumab (Tecentriq). Similarly, he stated that patients with previously untreated HRD-positive metastatic prostate cancer also see a progression-free survival benefit when a PARP inhibitor is added to an androgen deprivation therapy/androgen receptor pathway inhibitor backbone. Shifting the conversation to the management of frontline advanced clear cell renal cell carcinoma (RCC), the experts reviewed standard approaches, which involve an immune-oncology (IO) agent plus either a CTLA-4 inhibitor or a VEGF TKI. Tagawa noted that IO/VEGF TKI combinations may be preferred for symptomatic patients needing a rapid response, whereas IO/IO combinations may offer greater potential for treatment cessation. He brought up a key distinction in RCC, which is that re-instituting PD-1/PD-L1 inhibition upon progression in the metastatic setting has generally shown no benefit. Dr Levy brought a broad scope to the GU cancer discussion through his lung cancer expertise, introducing parallels between the treatment paradigms. The interview provided an opportunity to show the importance of creating connections across oncology specialties to bring nuanced perspectives to future advances in clinical research and patient care.
In this episode of the Oncology Brothers podcast, we dive into the groundbreaking data presented at ESMO 2025, focusing on the GU landscape, particularly prostate and bladder cancer. Join us as we welcome Dr. Stephanie Berg, a GU medical oncologist from the Dana-Farber Cancer Institute, to discuss key studies and their implications for patient care. Episode Highlights: PSMAddition: Explore the benefits of lutetium PSMA in metastatic hormone-sensitive prostate cancer, including improved radiographic progression-free survival when combined with ADT and ARPIs. Capitello-281: Highlights the use of Capivasertib in patients with PTEN loss, showing significant improvements in radiographic PFS. Potomac: Examining the role of durvalumab + BCG in high-risk non-muscle invasive bladder cancer, and the promising results from the Keynote 905 study involving enfortumab and pembrolizumab. IMVigor011: Delved into showcasing how ctDNA-guided therapy with atezolizumab can improve survival outcomes. Stay tuned as we navigate the complexities of treatment options, side effects, and the importance of patient-centered decision-making in oncology. Follow us on social media: • X/Twitter: https://twitter.com/oncbrothers • Instagram: https://www.instagram.com/oncbrothers • Website: https://oncbrothers.com/ Don't forget to subscribe for more insights on treatment algorithms, FDA approvals, and conference highlights! #ESMO2025 #GUOncology #LutetiumPSMA #Enfortumab #BladderCancer #ProstateCancer #OncologyBrothers
In this episode, Prof. Scott Tagawa (US), a medical oncologist at Weill Cornell Medicine in New York, discusses the results of PSMAddition - a phase III trial of [177Lu]Lu-PSMA-617 combined with ADT + ARPI in patients with PSMA-positive metastatic hormone-sensitive prostate cancer. This interview was recorded at ESMO 2025 in Berlin, Germany. For more updates on prostate cancer, please visit our educational platform UROONCO PCa.For more EAU podcasts, please go to your favourite podcast app and subscribe to our podcast channel for regular updates: Apple Podcasts, Spotify, EAU YouTube channel.
En esta cápsula de ESMO 2025 EXPRESS, el Dr. Pablo Álvarez Ballesteros, oncólogo médico adscrito al Hospital 12 de Octubre de Madrid, España, nos presenta los highlights de tumores genitourinarios presentados durante el Congreso Anual de la Sociedad Europea de Oncología Médica 2025.El experto comenta lo siguiente: Durante el Congreso Anual de la Sociedad Europea de Oncología Médica 2025, los tumores genitourinarios ocuparon un papel protagonista, con múltiples ensayos fase III presentados en sesiones presidenciales que redefinen el abordaje terapéutico del cáncer urotelial y prostático. El estudio EV-303 demostró que la combinación neoadyuvante de enfortumab vedotin + pembrolizumabmejora significativamente la supervivencia libre de progresión frente a la cistectomía inmediata en pacientes con cáncer de vejiga músculo-invasivo inelegibles para cisplatino, con tasas de respuesta patológica completa cercanas al 60%. El ensayo IMvigor011 validó el uso de ADN tumoral circulante (ctDNA, por sus siglas en inglés) como herramienta de estratificación en el contexto adyuvante: los pacientes conctDNA negativo alcanzaron una tasa de recaída del 5% al año, mientras que los ctDNA positivos se beneficiaron moderadamente de atezolizumab, confirmando el valor predictivo del ctDNA para el riesgo de recaída. En la población metastásica, un estudio fase III de origen chino mostró que la combinación disitamab vedotin + toripalimab superó de forma significativa a carboplatino-gemcitabina, tanto en supervivencia libre de progresión (HR=0.4–0.5) como en supervivencia global, aunque con la limitación de haberse realizado exclusivamente en pacientes asiáticos y sin mantenimiento con avelumab. El estudio DISCUS sugirió que tres ciclos de quimioterapia con carboplatino-gemcitabina seguidos de avelumab son no inferiores a seis ciclos, mejorando la calidad de vida pormenor exposición a quimioterapia. Por último, el ensayo PSMAddition en cáncer de próstata hormonosensible metastásico mostró una mejora en lasupervivencia libre de progresión al añadir lutecio-PSMA a enzalutamida, aunque sin alcanzar aún significación estadística en supervivencia global. Los resultados de 2025 consolidan el papel de las combinaciones de anticuerpos conjugados con fármacose inmunoterapia en el cáncer urotelial, y abren nuevas perspectivas de tratamiento personalizado basadas en biomarcadores como el ctDNA. Fecha de grabación: 20 de octubre de 2025 Material exclusivo para profesionales de la salud. Este material ha sido desarrollado únicamente con fines educativos e informativos y no tiene la intención de sustituir eljuicio clínico de los profesionales de la salud. Las opiniones y declaraciones presentadas en este contenido son responsabilidad exclusiva de los ponentes y no reflejan necesariamente la postura institucional de ScienceLink ni deterceros mencionados. La información presentada se basa en el conocimiento y la experiencia profesional de los ponentes. La veracidad, exactitud y actualidad científica de los datos son de su exclusiva responsabilidad. Así mismo garantizan que el contenido utilizado no infringe derechos de autor de tercerosy asumen toda responsabilidad por su uso. Se deberán de revisar las indicaciones aprobadas en el país con estricto apego al marco regulatorio aplicable para cada uno de los tratamientos y medicamentos comentados. ESMO® es una marca registrada de la European Society For Medical Oncology. Este material ha sido producido de manera independiente y no está autorizado, patrocinado ni avaladopor dicha organización.
Hot off the press in the Presidential Plenary at #ESMO25, we chat with Dr Scott Tagawa (Weill-Cornell, USA) about the positive data he just presented from the PSMAddition trial. This is an eagerly awaited phase III randmosied trial of patients with mHSPC, to see if the addition of six cycles of Lu-PSMA-617 to a control arm of ADT and an ARPI, could improve rPFS and other endpoints. We are also joined in the studio by Prof Michael Hofman (Peter MacCallum Cancer Centre, AUS), co-PI of the UpFront PSMA trial which also explored a similar concept, plus some comments from our other colleague, prof Arun Azad, who was the Discussant in the Presidential at ESMO25. Declan Murphy hosting GU Cast solo today while Renu Eapen was in the OR doing surgery. Even better on our YouTube channelThis is a Themed Podcast supported by our Silver Partners, Novartis.
Dr. Rahul Aggarwal presents emerging treatments for advanced prostate cancer, highlighting rapid advances in drug development. He outlines therapies targeting cancer cell surface proteins beyond PSMA, including CD46, B7-H3, and DLL3, and explains how antibody-drug conjugates deliver potent chemotherapy directly to tumors. He also discusses bispecific T-cell engagers designed to trigger immune attacks on cancer cells, including promising results from agents like Talquetamab. Aggarwal explores new isotopes such as actinium-225 for radioligand therapy, which may offer stronger and more durable responses than current treatments. He emphasizes continued innovation in targeting the androgen receptor, with drugs that degrade the receptor or block androgen production more effectively than existing therapies. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40813]
Dr. Rahul Aggarwal presents emerging treatments for advanced prostate cancer, highlighting rapid advances in drug development. He outlines therapies targeting cancer cell surface proteins beyond PSMA, including CD46, B7-H3, and DLL3, and explains how antibody-drug conjugates deliver potent chemotherapy directly to tumors. He also discusses bispecific T-cell engagers designed to trigger immune attacks on cancer cells, including promising results from agents like Talquetamab. Aggarwal explores new isotopes such as actinium-225 for radioligand therapy, which may offer stronger and more durable responses than current treatments. He emphasizes continued innovation in targeting the androgen receptor, with drugs that degrade the receptor or block androgen production more effectively than existing therapies. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40813]
Dr. Rahul Aggarwal presents emerging treatments for advanced prostate cancer, highlighting rapid advances in drug development. He outlines therapies targeting cancer cell surface proteins beyond PSMA, including CD46, B7-H3, and DLL3, and explains how antibody-drug conjugates deliver potent chemotherapy directly to tumors. He also discusses bispecific T-cell engagers designed to trigger immune attacks on cancer cells, including promising results from agents like Talquetamab. Aggarwal explores new isotopes such as actinium-225 for radioligand therapy, which may offer stronger and more durable responses than current treatments. He emphasizes continued innovation in targeting the androgen receptor, with drugs that degrade the receptor or block androgen production more effectively than existing therapies. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40813]
Dr. Rahul Aggarwal presents emerging treatments for advanced prostate cancer, highlighting rapid advances in drug development. He outlines therapies targeting cancer cell surface proteins beyond PSMA, including CD46, B7-H3, and DLL3, and explains how antibody-drug conjugates deliver potent chemotherapy directly to tumors. He also discusses bispecific T-cell engagers designed to trigger immune attacks on cancer cells, including promising results from agents like Talquetamab. Aggarwal explores new isotopes such as actinium-225 for radioligand therapy, which may offer stronger and more durable responses than current treatments. He emphasizes continued innovation in targeting the androgen receptor, with drugs that degrade the receptor or block androgen production more effectively than existing therapies. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40813]
Dr. Rahul Aggarwal presents emerging treatments for advanced prostate cancer, highlighting rapid advances in drug development. He outlines therapies targeting cancer cell surface proteins beyond PSMA, including CD46, B7-H3, and DLL3, and explains how antibody-drug conjugates deliver potent chemotherapy directly to tumors. He also discusses bispecific T-cell engagers designed to trigger immune attacks on cancer cells, including promising results from agents like Talquetamab. Aggarwal explores new isotopes such as actinium-225 for radioligand therapy, which may offer stronger and more durable responses than current treatments. He emphasizes continued innovation in targeting the androgen receptor, with drugs that degrade the receptor or block androgen production more effectively than existing therapies. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40813]
Experts present new tools for managing PSA-recurrent prostate cancer. Dr. Steven Seyedin describes how PET/CT imaging enhances detection by reducing false positives and improving staging accuracy. Dr. Thomas Hope highlights PSMA PET imaging, now the standard approach, which identifies cancer more precisely by targeting tumor-specific proteins. Dr. Julian Hong discusses stereotactic body radiation therapy (SBRT) for patients with limited metastases, showing that it offers effective, low-toxicity treatment while preserving quality of life. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40867]
Experts present new tools for managing PSA-recurrent prostate cancer. Dr. Steven Seyedin describes how PET/CT imaging enhances detection by reducing false positives and improving staging accuracy. Dr. Thomas Hope highlights PSMA PET imaging, now the standard approach, which identifies cancer more precisely by targeting tumor-specific proteins. Dr. Julian Hong discusses stereotactic body radiation therapy (SBRT) for patients with limited metastases, showing that it offers effective, low-toxicity treatment while preserving quality of life. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40867]
Experts present new tools for managing PSA-recurrent prostate cancer. Dr. Steven Seyedin describes how PET/CT imaging enhances detection by reducing false positives and improving staging accuracy. Dr. Thomas Hope highlights PSMA PET imaging, now the standard approach, which identifies cancer more precisely by targeting tumor-specific proteins. Dr. Julian Hong discusses stereotactic body radiation therapy (SBRT) for patients with limited metastases, showing that it offers effective, low-toxicity treatment while preserving quality of life. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40867]
Experts present new tools for managing PSA-recurrent prostate cancer. Dr. Steven Seyedin describes how PET/CT imaging enhances detection by reducing false positives and improving staging accuracy. Dr. Thomas Hope highlights PSMA PET imaging, now the standard approach, which identifies cancer more precisely by targeting tumor-specific proteins. Dr. Julian Hong discusses stereotactic body radiation therapy (SBRT) for patients with limited metastases, showing that it offers effective, low-toxicity treatment while preserving quality of life. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40867]
Experts present new tools for managing PSA-recurrent prostate cancer. Dr. Steven Seyedin describes how PET/CT imaging enhances detection by reducing false positives and improving staging accuracy. Dr. Thomas Hope highlights PSMA PET imaging, now the standard approach, which identifies cancer more precisely by targeting tumor-specific proteins. Dr. Julian Hong discusses stereotactic body radiation therapy (SBRT) for patients with limited metastases, showing that it offers effective, low-toxicity treatment while preserving quality of life. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40867]
Experts from UCSF outline the latest treatments and research for advanced prostate cancer, highlighting improved outcomes and promising therapies. Dr. Kelly Fitzgerald reviews intensified androgen deprivation therapy (ADT) and the evolving role of imaging, triplet therapy, and local treatments. Dr. Ivan de Kouchkovsky shares how radioligand therapies like Lutetium-177 PSMA target cancer with precision and are now approved earlier in care. Dr. David Oh explains immunotherapy strategies, including cancer vaccines and checkpoint inhibitors, and explores new options like bispecific T-cell engagers. Dr. Terry Friedlander discusses bone health and the impact of hormone therapy, offering strategies to reduce fracture risk and improve quality of life. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40868]
Dr. Pedro Barata and Dr. Rana McKay discuss the integration of innovative advances in molecular imaging and therapeutics to personalize treatment for patients with renal cell and urothelial carcinomas. TRANSCRIPT Dr. Pedro Barata: Hello, I'm Dr. Pedro Barata, your guest host of By the Book, a podcast series featuring insightful conversations between authors and editors of the ASCO Educational Book. I'm a medical oncologist at University Hospitals Seidman Cancer Center and an associate professor of medicine at Case Western Reserve University in Cleveland, Ohio. I'm also an associate editor of the ASCO Educational Book. Now, we all know the field of genitourinary cancers (GU) is evolving quite rapidly, and we have new innovations in molecular imaging as well as targeted therapeutics. Today's episode will be exploring novel approaches that are transforming the management of renal cell and urothelial carcinomas and also their potential to offer a more personalized treatment to patients. For that, joining for today's discussion is Dr. Rana McKay, a GU medical oncologist and professor at University of California San Diego. Dr. McKay will discuss her recently published article titled, “Emerging Paradigms in Genitourinary Cancers: Integrating Molecular Imaging, Hypoxia-Inducible Factor-Targeted Therapies, and Antibody-Drug Conjugates in Renal Cell and Urothelial Carcinomas.” Our full disclosures are available in the transcript of this episode. And with that, Rana McKay, great to have you on the podcast today. Dr. Rana McKay: Oh, thank you so much, Dr. Barata. It's really wonderful to be here with you. So, thanks for hosting. Dr. Pedro Barata: No, thanks for taking the time, and I'm looking forward to this conversation. And by the way, let me start by saying congrats on a great article in the Educational Book. Really super helpful paper. I'm recommending it to a lot of the residents and fellows at my own institution. I would like to first ask you to kind of give our listeners some context of how novel approaches in the molecular imaging as well as targeted therapeutics are actually changing the way we're managing patients with GU, but specifically with renal cell carcinoma and urothelial carcinoma. So, what are the areas you would call out as like being big areas for innovation in this context, and why are they important? Dr. Rana McKay: Very good question. And I think this is really what this article highlights. It highlights where are we going from an imaging diagnostics standpoint? Where are we going from a therapeutic standpoint? And I think if we have to step back, from the standpoint of diagnostics, we've seen PET imaging really transform diagnostics in prostate cancer with the advent of PSMA PET imaging, and now PSMA PET imaging is used as a biomarker for selection for theranostics therapy. And so, we're starting to see that enter into the RCC landscape, enter into the urothelial cancer landscape to a lesser extent. And I think it's going to potentially be transformative as these tools get more refined. I think when we think about therapeutics, what's been transformative most recently in the renal cell carcinoma landscape has been the advent of HIF2α inhibition to improve outcomes for patients. And we have seen the approval of belzutifan most recently that has reshaped the landscape. And now there's other HIF2α inhibitors that are being developed that are going to be further important as they get refined. And lastly, I think when we think about urothelial carcinoma, the greatest transformation to treatment in that context has been the displacement of cisplatin and platinum-based chemotherapy as a frontline standard with the combination of enfortumab vedotin plus pembrolizumab. And we've seen antibody-drug conjugates really reshape treatment and tremendously improve outcomes for patients. So, I think those are the three key areas of interest. Dr. Pedro Barata: So with that, let's focus first on the imaging and then we'll get to the therapeutic area. So, we know there's been a paradigm shift, really, when prostate-specific targets emerged as tracers for PET scanning. And so, we now commonly use prostate-specific membrane antigen, or PSMA-based PET scanning, and really transform how we manage prostate cancer. Now, it appears that we're kind of seeing a similar wave in renal cell carcinoma with the new radiotracer against the target carbonic anhydrase IX. What can you tell us about this? And is this going to be available to us anytime soon? And how do you think that might potentially change the way we're managing patients with RCC today? Dr. Rana McKay: First, I'll step back and say that in the context of PSMA PET imaging, we have actually been able to better understand RCC as well. So, we know that PSMA is expressed in the neovasculature of tumors, and it can actually be used to detect renal cell carcinoma tumors. It has a detection rate of about 84% when used for detection. And so, you know, I don't think it's just restricted to carbonic anhydrase IX, but we will talk about that. So, PSMA expressed in the neovasculature has a detection rate of around 84%, particularly if we're looking at clear cell RCC. CAlX is overexpressed in clear cell RCC, and it's actually used in diagnosing renal cell carcinoma when we think of CAlX IHC for diagnosing clear cell RCC. And now there are CAlX PET tracers. The first foray was with the ZIRCON study that was actually an interestingly designed study because it was designed to detect the likelihood of PET imaging to identify clear cell RCC. So, it was actually used in the early diagnostics setting when somebody presents with a renal mass to discriminate that renal mass from a clear cell versus a non-clear cell, and it was a positive study. But when I think about the potential application for these agents, you know, I think about the entire landscape of renal cell carcinoma. This is a disease that we do treat with metastasis-directed therapy. We have certainly seen patients who've undergone metastasectomy have long, durable remissions from such an approach. And I think if we can detect very early onset oligometastatic disease where a metastasis-directed therapy or SABR could be introduced - obviously tested in a trial to demonstrate its efficacy - I think it could potentially be transformative. Dr. Pedro Barata: Wonderful. It's a great summary, and I should highlight you are involved in some of those ongoing studies testing the performance of this specific PET scanning for RCC against conventional imaging, right? And to remind the listeners, thus far, for the most part, we don't really do FDG-PET for RCC. There are some specific cases we do, but in general, they're not a standard scanning. But maybe that will change in the future. Maybe RCC will have their own PSMA-PET. And to your point, there's also emerging data about the role of PSMA-PET scanning in RCC as well, as you very elegantly summarized. Wonderful. So, let me shift gears a little bit because you did, in your introduction, you did highlight a novel MOA that we have in renal cell carcinoma, approved for use, initially for VHL disease, and after that for sporadic clear cell renal cell carcinoma. We're talking about hypoxia-inducible factor 2-alpha inhibitors, or HIF2α inhibitors, such as belzutifan. But there's also others coming up. So, as a way to kind of summarize that, what can you tell us about this breakthrough in terms of therapeutic class, this MOA that got to our toolbox of options for patients with advanced RCC? Tell us a little bit what is being utilized currently in the management of advanced RCC. And where do you see the future going, as far as, is it moving early on? Is it getting monotherapy versus combinations? Maybe other therapies? What are your thoughts about that? What can you tell us about it? Dr. Rana McKay: Belzutifan is a first-in-class HIF2α inhibitor that really established clinical validation for HIF2α as a therapeutic target. When we think about the activity of this agent, the pivotal LITESPARK-005 trial really led to the approval of belzutifan in patients who were really heavily pretreated. It was patients who had received prior IO therapy, patients who had received prior VEGF-targeted therapy. And in the context of this study, we saw a median PFS of 5.6 months, and there did seem to be a tail on the curve when you looked at the 12-month PFS rate with belzutifan. It was 33.7% compared to 17.6% with everolimus. And then when we look at the response rate, it was higher with belzutifan on the order of 22-23%, and very low with everolimus, as we've previously seen. I think one of the Achilles heels of this regimen is the primary PD rate, which was 34% when used in later line. There are multiple studies that are testing belzutifan in combination across the treatment landscape. So, we have LITESPARK-011, which is looking at the combination of belzutifan plus lenvatinib in the second-line setting. We've got the MK-012 [LITESPARK-012] study, which is looking at belzutifan in various combinations in the frontline setting. So there is a combination with IO plus belzutifan. And so this is also being looked at in that context. And then we also have the LITESPARK-022 study, which is looking at pembrolizumab with belzutifan in the adjuvant setting. So there's a series of studies that will be exploring belzutifan really across the treatment landscape. Many of these studies in combination. Additionally, there are other HIF2α inhibitors that are being developed. We have casdatifan, which is another very potent HIF2α inhibitor. You know, I think pharmacologically, these are different agents. There's a different half-life, different dosing. What is going to be the recommended phase 3 dose for both agents, the EPO suppression levels, the degree of EPO suppression, and sustainability of EPO suppression is very different. So, I think we've seen data from casdatifan from the ARC-20 trial from monotherapy with a respectable response rate, over 30%, primary PD rate hovering just around 10%. And then we've also seen data of the combination of casdatifan with cabozantinib as well that were recently presented this year. And that agent is also being tested across the spectrum of RCC. It's being looked at in combination with cabozantinib in the PEAK-1 study, and actually just at the KCRS (Kidney Cancer Research Summit), we saw the unveiling of the eVOLVE-RCC trial, which is going to be looking at a volrustomig, which is a PD-1/CTLA-4 inhibitor plus casdatifan compared to nivo-ipi in the frontline setting. So, we're going to see some competition in this space of the HIF2α inhibitors. I think when we think of mechanism of action in that these are very potent, not a lot of off-target activity, and they target a driver mutation in the disease. And that driver mutation happens very early in the pathogenesis. These are going to be positioned much earlier in the treatment landscape. Dr. Pedro Barata: All these studies, as you're saying, look really promising. And when we talk about them, you mentioned a lot of combinations. And to me, when I think of these agents, it makes a lot of sense to combine because there's not a lot of overlapping toxicities, if you will. But perhaps for some of our listeners, who have not used HIF2α inhibitors in practice yet, and they might be thinking about that, what can you tell us about the safety profile? How do you present it to your patients, and how do you handle things like hypoxia or anemia? How do you walk through the safety profile and tolerability profile of those agents like belzutifan? Dr. Rana McKay: I think these drugs are very different than your traditional TKIs, and they don't cause the classic symptoms that are associated with traditional TKIs that many of us are very familiar with like the rash, hand-foot syndrome, hypertension, diarrhea. And honestly, these are very nuanced symptoms that patients really struggle with the chronicity of being on a chronic daily TKI. The three key side effects that I warn patients about with HIF2α inhibitors are: (1) fatigue; (2) anemia; and (3) hypoxia and dysregulation in the ability to sense oxygen levels. And so, many of these side effects - actually, all of them - are very dose-dependent. They can be very well-managed. So, we can start off with the anemia. I think it's critically important before you even start somebody on belzutifan that you are optimizing their hemoglobin and bone marrow function. Make sure they don't have an underlying iron deficiency anemia. Make sure they don't have B12 or folate deficiency. Check for these parameters. Many patients who have kidney cancer may have some hematuria, other things where there could be some low-level blood loss. So, make sure that those are resolved or you're at least addressing them and supplementing people appropriately. I monitor anemia very closely every 3 to 4 weeks, at least, when people start on these medications. And I do initiate EPO, erythropoietin, should the anemia start to worsen. And I typically use a threshold of around 10g/dL for implementing utilization of an EPO agent, and that's been done very safely in the context of the early studies and phase 3 studies as well. Now, with regards to the hypoxia, I think it's also important to make sure that you're selecting the appropriate individual for this treatment. People who have underlying COPD, or even those individuals who have just a very high burden of disease in their lung, lymphangitic spread, pleural effusions, maybe they're already on oxygen - that's not an ideal candidate for belzutifan. Something that very easily can be done in the clinic before you think about initiating somebody on this treatment, and has certainly been integrated into some of the trials, is just a 6-minute walk test. You know, have the patient walk around the clinic with one of the MAs, one of the nurses, put the O2 sat on [measuring oxygen saturation], make sure they're doing okay. But these side effects, like I said, are very dose-dependent. Typically, if a patient requires, if the symptoms are severe, the therapy can be discontinued and dose reduced. The standing dose is 120 mg daily, and there's two dose reductions to 80 mg and 40 mg should somebody warrant that dose modification. Dr. Pedro Barata: This is relatively new, right? Like, it was not that we're used to checking oxygen levels, right? In general, we're treating these patients, so I certainly think there's a learning curve there, and some of the points that you highlight are truly critical. And I do share many of those as well in our practice. Since I have you, I want to make sure we touch base on antibody-drug conjugates as well. It's also been a hot area, a lot of developments there. When I think of urothelial carcinoma and renal cell carcinoma, I see it a little bit different. I think perhaps in urothelial carcinoma, antibody-drug conjugates, or ADCs, are somewhat established already. You already mentioned enfortumab vedotin. I might ask you to expand a little bit on that. And then in renal cell carcinoma, we have some ADCs as well that you include in your chapter, and that I would like you to tell us what's coming from that perspective. So, tell us a little bit about how do you see ADCs in general for GU tumors, particularly UC and RCC? Tell us a little bit about the complexity or perhaps the challenges you still see. At the same time, tell us about the successes. Dr. Rana McKay: Stepping back, let's just talk about like the principles and design of ADCs. So, most ADCs have three components. There's a monoclonal antibody that typically targets a cell surface antigen, which is conjugated by a linker, which is the second component, to a payload drug. And typically, that payload drug has been chemotherapy, whether it be topoisomerase or whether it be MMAE or other chemotherapeutic. We can start in the RCC space. There's been multiple antibody-drug conjugates that have been tested. There's antibody-drug conjugates to CD70, which is expressed on clear cell RCC. There's been antibody-drug conjugates to ENPP3, which is also expressed on RCC. There's antibody-drug conjugates to CDH6. And they have different payloads, like I said, whether it be topoisomerase I or other microtubule inhibitors. Now, when we think about kidney cancer, we don't treat this disease with chemotherapy. This disease is treated with immunotherapy. It is treated with treatments that target the VEGF pathway and historically has not been sensitive to chemo. So, I think even though the targets have been very exciting, we've seen very underwhelming data regarding activity, and in some context, seen increased toxicity with the ADCs. So, I think we need to tread lightly in the context of the integration and the testing of ADCs in RCC. We just came back from the KCRS meeting, and there was some very intriguing data about a c-Kit ADC that's being developed for chromophobe RCC, which is, you know, a huge unmet need, these variant tumors that really lack appropriate therapeutics. But I just caution us to tread lightly around how can we optimize the payload to make sure that the tumor that we're treating is actually sensitive to the agent that's targeting the cell kill. So, that's a little bit on the ADCs in RCC. I still think we have a long way to go and still in early testing. Now, ADCs for UC are now the standard of care. I think the prototypical agent, enfortumab vedotin, is a nectin-4-directed ADC that's conjugated to an MMAE payload and was the first ADC approved for advanced urothelial, received accelerated approval following the EV-201 trial, which was basically a multicenter, single-arm study that was investigating EV in cisplatin-ineligible patients with advanced urothelial carcinoma, and then ultimately confirmed in the EV-301 study as well. And so, that study ended up demonstrating the support superiority of EV from an overall survival standpoint, even PFS standpoint. Building on that backbone is the EV-302 study, which tested EV in combination with pembrolizumab versus platinum-based chemotherapy in the frontline setting. And that was a pivotal, landmark study that, like I said, has displaced platinum therapy as a frontline treatment for people with advanced urothelial carcinoma. And when we think about that study and the median overall survival and just how far we've come in urothelial cancer, the median OS with EV-pembro from that trial was 31 and a half months. I mean, that's just incredible. The control arm survival was 16 and a half months. The hazard ratio for OS, 0.47. I mean this is why when this data was presented, it was literally a standing ovation that lasted for several minutes because we just haven't seen data that have looked that good. And there are other antibody-drug conjugates that are being tested. We've all been involved in the saga with sacituzumab govitecan, which is a trophoblast cell surface antigen 2 (Trop-2) targeted ADC with a topoisomerase I payload. It was the second ADC to receive approval, but then that approval was subsequently withdrawn when the confirmatory phase 3 was negative, the TROPiCS-04 trial. So, approval was granted based off of the TROPHY-U-01, single-arm, phase 2 study, demonstrating a response rate of around 28% and a PFS of, you know, about 5 and a half months. But then failure to show any benefit from an OS standpoint. And I think there's a lot of controversy in the field around whether this agent still has a role in advanced urothelial carcinoma. And I think particularly for individuals who do not have molecular targets, like they're not HER2-amplified or have HER2-positivity or FGFR or other things like that. Dr. Pedro Barata: Fantastic summary, Rana. You were talking about the EV, and it came to mind that it might not be over, right, for the number of ADCs we use in clinical practice in the near future. I mean, we've seen very promising data for ADC against the HER2, right, and over-expression. It also can create some challenges, right, in the clinics because we're asking to test for HER2 expression. It's almost like, it's not exactly the same to do it in breast cancer, but it looks one more time that we're a little bit behind the breast cancer field in a lot of angles. And also has vedotin as a payload. Of course, I'm referring to disitamab vedotin, and there's very elegant data described by you in your review chapter as well. And it's going to be very interesting to see how we sequence the different ADCs, to your point as well. So, before we wrap it up, I just want to give you the opportunity to tell us if there's any area that we have not touched, any take-home points you'd like to bring up for our listeners before we call it a day. Dr. Rana McKay: Thank you so much. I have to say, you know, I was so excited at ASCO this year looking at the GU program. It was fantastic to see the progress being made, novel therapeutics that really there's a tremendous excitement about, not just in RCC and in UC, but also in prostate cancer, thinking about the integration of therapies, not just for people with refractory disease that, even though our goal is to improve survival, our likelihood of cure is low, but also thinking about how do we integrate these therapies early in the treatment landscape to enhance cure rates for patients, which is just really spectacular. We're seeing many of these agents move into the perioperative setting or in combination with radiation for localized disease. And then the special symposium on biomarkers, I mean, we've really come a long, long way. And I think that we're going to continue to evolve over the next several years. I'm super excited about where the field is going in the treatment of genitourinary malignancies. Dr. Pedro Barata: Oh, absolutely true. And I would say within the Annual Meeting, we have outstanding Educational Sessions. And just a reminder to the listeners that actually that's where the different teams or topics for the Educational Book chapters come from, from actually the educational sessions from ASCO. And your fantastic chapter is an example of that, right, focusing on advanced GU tumors. So, thank you so much, Rana, for taking the time, sharing your insights with us today on the podcast. It was a fantastic conversation as always. Dr. Rana McKay: My pleasure. Thanks so much for having me, Dr. Barata. Dr. Pedro Barata: Of course. And thank you to our listeners for your time today. You will find the link to the article discussed today in the transcript of this episode. I also encourage you to check out the 2025 ASCO Educational Book. You'll find an incredible wealth of information there. It's free, available online, and you'll find, hopefully, super, super important information on the key science and issues that are shaping modern oncology, as we've heard from Dr. McKay and many other outstanding authors. So, thank you, everyone, and I hope to see you soon. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Follow today's speakers: Dr. Pedro Barata @PBarataMD Dr. Rana McKay @DrRanaMcKay Follow ASCO on social media: @ASCO on X (formerly Twitter) ASCO on Bluesky ASCO on Facebook ASCO on LinkedIn Disclosures: Dr. Pedro Barata: Stock and Other Ownership Interests: Luminate Medical Honoraria: UroToday Consulting or Advisory Role: Bayer, BMS, Pfizer, EMD Serono, Eisai, Caris Life Sciences, AstraZeneca, Exelixis, AVEO, Merck, Ipson, Astellas Medivation, Novartis, Dendreon Speakers' Bureau: AstraZeneca, Merck, Caris Life Sciences, Bayer, Pfizer/Astellas Research Funding (Inst.): Exelixis, Blue Earth, AVEO, Pfizer, Merck Dr. Rana McKay: Consulting or Advisory Role: Janssen, Novartis, Tempus, Pfizer, Astellas Medivation, Dendreon, Bayer, Sanofi, Vividion, Calithera, Caris Life Sciences, Sorrento Therapeutics, AVEO, Seattle Genetics, Telix, Eli Lilly, Blue Earth Diagnostics, Ambrx, Sumitomo Pharma Oncology, Esiai, NeoMorph, Arcus Biosciences, Daiichi Sankyo, Exelixis, Bristol Myers Squibb, Merck, Astrazeneca, Myovant Research Funding (Inst.): Bayer, Tempus, AstraZeneca, Exelixis, Bristol Myers Squibb, Oncternal Therapeutics, Artera
Experts from UCSF outline the latest treatments and research for advanced prostate cancer, highlighting improved outcomes and promising therapies. Dr. Kelly Fitzgerald reviews intensified androgen deprivation therapy (ADT) and the evolving role of imaging, triplet therapy, and local treatments. Dr. Ivan de Kouchkovsky shares how radioligand therapies like Lutetium-177 PSMA target cancer with precision and are now approved earlier in care. Dr. David Oh explains immunotherapy strategies, including cancer vaccines and checkpoint inhibitors, and explores new options like bispecific T-cell engagers. Dr. Terry Friedlander discusses bone health and the impact of hormone therapy, offering strategies to reduce fracture risk and improve quality of life. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40868]
Experts from UCSF outline the latest treatments and research for advanced prostate cancer, highlighting improved outcomes and promising therapies. Dr. Kelly Fitzgerald reviews intensified androgen deprivation therapy (ADT) and the evolving role of imaging, triplet therapy, and local treatments. Dr. Ivan de Kouchkovsky shares how radioligand therapies like Lutetium-177 PSMA target cancer with precision and are now approved earlier in care. Dr. David Oh explains immunotherapy strategies, including cancer vaccines and checkpoint inhibitors, and explores new options like bispecific T-cell engagers. Dr. Terry Friedlander discusses bone health and the impact of hormone therapy, offering strategies to reduce fracture risk and improve quality of life. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40868]
Experts from UCSF outline the latest treatments and research for advanced prostate cancer, highlighting improved outcomes and promising therapies. Dr. Kelly Fitzgerald reviews intensified androgen deprivation therapy (ADT) and the evolving role of imaging, triplet therapy, and local treatments. Dr. Ivan de Kouchkovsky shares how radioligand therapies like Lutetium-177 PSMA target cancer with precision and are now approved earlier in care. Dr. David Oh explains immunotherapy strategies, including cancer vaccines and checkpoint inhibitors, and explores new options like bispecific T-cell engagers. Dr. Terry Friedlander discusses bone health and the impact of hormone therapy, offering strategies to reduce fracture risk and improve quality of life. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40868]
Experts from UCSF outline the latest treatments and research for advanced prostate cancer, highlighting improved outcomes and promising therapies. Dr. Kelly Fitzgerald reviews intensified androgen deprivation therapy (ADT) and the evolving role of imaging, triplet therapy, and local treatments. Dr. Ivan de Kouchkovsky shares how radioligand therapies like Lutetium-177 PSMA target cancer with precision and are now approved earlier in care. Dr. David Oh explains immunotherapy strategies, including cancer vaccines and checkpoint inhibitors, and explores new options like bispecific T-cell engagers. Dr. Terry Friedlander discusses bone health and the impact of hormone therapy, offering strategies to reduce fracture risk and improve quality of life. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40868]
The New Chemist's Podcasting Group: The Path to KOLs — Interview with Dr. Michael A. Morris, MD, MS, DABR, DABNM, DCI — Co-Founder, United Theranostics---
Dr. Ivan de Kouchkovsky explains how radioligand therapy delivers targeted radiation to prostate cancer cells using a radioactive isotope attached to a molecule that binds to PSMA, a protein commonly expressed in these tumors. He reviews key clinical trials showing how the therapy improves survival and quality of life for men with metastatic castration-resistant prostate cancer, both after and before chemotherapy. The FDA now approves this approach for patients who have progressed on hormone therapy, even if they haven't yet received chemotherapy. De Kouchkovsky also highlights efforts to enhance effectiveness by combining therapies, increasing radiation dose, and targeting resistant or PSMA-negative cells. Diagnostic imaging plays a critical role in selecting patients most likely to benefit from treatment. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40810]
Dr. Ivan de Kouchkovsky explains how radioligand therapy delivers targeted radiation to prostate cancer cells using a radioactive isotope attached to a molecule that binds to PSMA, a protein commonly expressed in these tumors. He reviews key clinical trials showing how the therapy improves survival and quality of life for men with metastatic castration-resistant prostate cancer, both after and before chemotherapy. The FDA now approves this approach for patients who have progressed on hormone therapy, even if they haven't yet received chemotherapy. De Kouchkovsky also highlights efforts to enhance effectiveness by combining therapies, increasing radiation dose, and targeting resistant or PSMA-negative cells. Diagnostic imaging plays a critical role in selecting patients most likely to benefit from treatment. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40810]
Dr. Ivan de Kouchkovsky explains how radioligand therapy delivers targeted radiation to prostate cancer cells using a radioactive isotope attached to a molecule that binds to PSMA, a protein commonly expressed in these tumors. He reviews key clinical trials showing how the therapy improves survival and quality of life for men with metastatic castration-resistant prostate cancer, both after and before chemotherapy. The FDA now approves this approach for patients who have progressed on hormone therapy, even if they haven't yet received chemotherapy. De Kouchkovsky also highlights efforts to enhance effectiveness by combining therapies, increasing radiation dose, and targeting resistant or PSMA-negative cells. Diagnostic imaging plays a critical role in selecting patients most likely to benefit from treatment. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40810]
Dr. Ivan de Kouchkovsky explains how radioligand therapy delivers targeted radiation to prostate cancer cells using a radioactive isotope attached to a molecule that binds to PSMA, a protein commonly expressed in these tumors. He reviews key clinical trials showing how the therapy improves survival and quality of life for men with metastatic castration-resistant prostate cancer, both after and before chemotherapy. The FDA now approves this approach for patients who have progressed on hormone therapy, even if they haven't yet received chemotherapy. De Kouchkovsky also highlights efforts to enhance effectiveness by combining therapies, increasing radiation dose, and targeting resistant or PSMA-negative cells. Diagnostic imaging plays a critical role in selecting patients most likely to benefit from treatment. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40810]
Dr. Ivan de Kouchkovsky explains how radioligand therapy delivers targeted radiation to prostate cancer cells using a radioactive isotope attached to a molecule that binds to PSMA, a protein commonly expressed in these tumors. He reviews key clinical trials showing how the therapy improves survival and quality of life for men with metastatic castration-resistant prostate cancer, both after and before chemotherapy. The FDA now approves this approach for patients who have progressed on hormone therapy, even if they haven't yet received chemotherapy. De Kouchkovsky also highlights efforts to enhance effectiveness by combining therapies, increasing radiation dose, and targeting resistant or PSMA-negative cells. Diagnostic imaging plays a critical role in selecting patients most likely to benefit from treatment. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40810]
Dr Bill Nelson and Dr Michael Carducci discuss using Prostate-Specific Membrane Antigen (PSMA) targeted therapies to detect and treat prostate cancer.
“Next-generation sequencing, or NGS, can be used to help us determine if the patient has specific biomarkers we can identify and use to target for treatment. Certain findings can tell us if a particular treatment might work for that patient, and we can see if there are any genetic variants we might have a biomarker targeted agent to use to treat them with,” ONS member Jackie Peterson, MSN, RN, OCN®, NE-BC, MBA, ambulatory nurse manager at the University of Chicago Medical Center in Illinois, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a conversation about prostate cancer and biomarker testing. This podcast is sponsored by AstraZeneca and is not eligible for NCPD contact hours. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications. Music Credit: “Fireflies and Stardust” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Episode Notes This episode is not eligible for NCPD. ONS Podcast™ episodes: Episode 324: Pharmacology 101: LHRH Antagonists and Agonists Episode 321: Pharmacology 101: CYP17 Inhibitors Episode 180: Learn How Nurse Practitioners Use Biomarker Testing in Cancer Care ONS Voice articles: An Oncology Nurse's Guide to Cascade Testing Genetic Disorder Reference Sheet: BRCA1 and BRCA2 Hereditary Disorders Genetic Disorder Reference Sheet: Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer) Germline and Somatic Variants: What Is the Difference? Help Patients Understand Genomic Variants of Unknown Significance Prostate Cancer Clinical Trials Don't Reflect Racial Diversity—And It's Getting Worse Over Time Prostate Cancer Disparities Disappear With Equal Access to Care Prostate Cancer Prevention, Screening, Treatment, and Survivorship Recommendations The Case of the Genomics-Guided Care for Prostate Cancer ONS book: Understanding Genomic and Hereditary Cancer Risk: A Handbook for Oncology Nurses ONS course: Genomic Foundations for Precision Oncology Clinical Journal of Oncology Nursing articles: Metastatic Prostate Cancer: An Update on Treatments and a Review of Patient Symptom Management Prostate Cancer: How Nurse Practicioners Can Aid in Disease Diagnosis and Management Oncology Nursing Forum article: Identification of Symptom Profiles in Prostate Cancer Survivors Other ONS Resources: Biomarker Database (refine by prostate cancer or specific biomarkers) Clinical tool/case study: Biomarker Testing in Prostate Cancer: The Role of the Oncology Nurse Genomics and Precision Oncology Learning Library Huddle Card: Genomic Biomarkers Infographic: Talking to Your Patient About a Germline Variant of Uncertain Significance (VUS) American Cancer Society - Genetic Testing and Counseling for Prostate Cancer Risk American Cancer Society - Prostate Cancer Clinicaltrials.gov National Cancer Institute - Prostate Cancer National Comprehensive Cancer Network ZERO Prostate Cancer To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode “Some of the risk factors for developing prostate cancer include age, race, family history, and certain genetic changes or variants. Prostate cancer has some hereditary components, but most prostate cancer occurs in men without any significant family history of it.” TS 1:31 “Key biomarkers include PSA and prostate cancer gene 3, which is PCA3, and prostate-specific membrane antigen, or PSMA. Other biomarkers that are important for us to test include BRCA1, BRCA2, and Lynch syndrome–associated genes, which are MLH1, MSH2, MSH6, PMS2, and EPCAM. Biomarkers can be collected via your blood, urine, saliva, or tissue samples, so these are different ways that we can test and look for biomarkers in our patients.” TS 3:24 “It does matter how advanced the disease is. Usually, for our castrate-sensitive patients, they respond better to androgen deprivation therapy because that really is slowing down the growth of the cancer by reducing the available testosterone that the cancer needs to grow. Whereas our patients that are more advanced and have castrate-resistant prostate cancer, that cancer will continue to grow despite having the lowered testosterone levels, so they might need additional layers of treatment to really get their cancer under control.” TS 7:50 “When I talk to [patients] about biomarker testing, I tell them it's another tool in our toolbox that we can use to help us determine if they might benefit from other therapy options now or in the future. I tell them that sometimes we'll get a report back with a variant of unknown significance, and basically that means that we don't really know whether or not this has an impact on their health or risk factors for the disease. That can sometimes be a little bit of a concern for these patients, so we just have to reassure them that we're continually doing research around biomarker testing. The science is always advancing, so if there's something that [researchers] find in the future, we'll make them aware of that.” TS 9:08 “One of the biggest topics I think about is the inequity that exists in biomarker testing and research, especially surrounding the African American population. When these tests were developed, that population really wasn't studied as much, so there's not a lot of good data yet to make a decision or impact on those patients and that population.” TS: 12:30
Marianne De Backer is the CEO of Vir Biotechnology, a company developing treatments that harness the power of the immune system to fight serious infectious diseases and cancer. Vir Biotechnology's current clinical trials include a registrational program in chronic hepatitis delta, a rare, often fatal liver disease, as well as two Phase 1 trials of PRO-XTEN™ dual-masked T-cell engagers (TCEs), one targeting HER-2 and the other targeting PSMA, each in heavily pre-treated cancer patients. TCEs have shown tremendous potential but have been limited due to toxicity challenges. The PRO-XTEN™ technology keeps the TCEs masked until they reach the tumor microenvironment, potentially mitigating the toxicity of TCEs and allowing them to unleash their tremendous potential to destroy cancer cells. Marianne explains, “Vir Biotechnology is an immunology company, and that means that we are really developing treatments that take advantage of the power of basically the patient's own immune system to fight a variety of diseases. We have actually four clinical-stage programs in infectious disease and oncology, and a number of preclinical programs as well. And our most advanced program is to treat chronic hepatitis delta. That is actually a disease caused by a tiny virus, but it's causing liver cancer and is often fatal.” “We have recently initiated our registrational phase 3 program. It's called ECLIPSE. We had previously shown some very compelling data with one of our regimens for treating this disease. We're really excited about progressing that program. And the rest of our clinical pipeline includes a series of so-called PRO-XTEN™ masked T-cell engagers, or in short, TCEs, for the treatment of metastatic solid tumors.” Vir Biotechnology has exclusive rights to the PRO-XTEN™ masking platform for oncology and infectious disease. PRO-XTEN™ is a trademark of Amunix Pharmaceuticals, Inc. a Sanofi company. #VirBiotechnology #MaskedTCellEngagers #TCellEngagers #SolidTumors #MetastaticSolidTumors #Cancer #Immunotherapy #ChronicHepatitisDelta #MedAI #PatientsAreWaiting vir.bio Listen to the podcast here
Marianne De Backer is the CEO of Vir Biotechnology, a company developing treatments that harness the power of the immune system to fight serious infectious diseases and cancer. Vir Biotechnology's current clinical trials include a registrational program in chronic hepatitis delta, a rare, often fatal liver disease, as well as two Phase 1 trials of PRO-XTEN™ dual-masked T-cell engagers (TCEs), one targeting HER-2 and the other targeting PSMA, each in heavily pre-treated cancer patients. TCEs have shown tremendous potential but have been limited due to toxicity challenges. The PRO-XTEN™ technology keeps the TCEs masked until they reach the tumor microenvironment, potentially mitigating the toxicity of TCEs and allowing them to unleash their tremendous potential to destroy cancer cells. Marianne explains, “Vir Biotechnology is an immunology company, and that means that we are really developing treatments that take advantage of the power of basically the patient's own immune system to fight a variety of diseases. We have actually four clinical-stage programs in infectious disease and oncology, and a number of preclinical programs as well. And our most advanced program is to treat chronic hepatitis delta. That is actually a disease caused by a tiny virus, but it's causing liver cancer and is often fatal.” “We have recently initiated our registrational phase 3 program. It's called ECLIPSE. We had previously shown some very compelling data with one of our regimens for treating this disease. We're really excited about progressing that program. And the rest of our clinical pipeline includes a series of so-called PRO-XTEN™ masked T-cell engagers, or in short, TCEs, for the treatment of metastatic solid tumors.” Vir Biotechnology has exclusive rights to the PRO-XTEN™ masking platform for oncology and infectious disease. PRO-XTEN™ is a trademark of Amunix Pharmaceuticals, Inc. a Sanofi company. #VirBiotechnology #MaskedTCellEngagers #TCellEngagers #SolidTumors #MetastaticSolidTumors #Cancer #Immunotherapy #ChronicHepatitisDelta #MedAI #PatientsAreWaiting vir.bio Download the transcript here
Dr. Kelly Fitzgerald explains current standards of care for metastatic hormone-sensitive prostate cancer, focusing on treatment strategies shaped by both clinical trial data and emerging imaging technologies. She defines key terms such as poly- and oligometastatic disease and outlines how newer imaging methods like PSMA PET scans are reshaping diagnosis. She describes the shift from traditional androgen deprivation therapy (ADT) to intensified ADT, where additional agents—such as chemotherapy or novel hormone therapies—are shown to improve survival. Fitzgerald also reviews ongoing questions around triplet therapy and the potential benefits of local treatments like radiation. She highlights the importance of patient-specific factors and the evolving definitions that influence treatment decisions in this complex disease landscape. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40809]
Dr. Kelly Fitzgerald explains current standards of care for metastatic hormone-sensitive prostate cancer, focusing on treatment strategies shaped by both clinical trial data and emerging imaging technologies. She defines key terms such as poly- and oligometastatic disease and outlines how newer imaging methods like PSMA PET scans are reshaping diagnosis. She describes the shift from traditional androgen deprivation therapy (ADT) to intensified ADT, where additional agents—such as chemotherapy or novel hormone therapies—are shown to improve survival. Fitzgerald also reviews ongoing questions around triplet therapy and the potential benefits of local treatments like radiation. She highlights the importance of patient-specific factors and the evolving definitions that influence treatment decisions in this complex disease landscape. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40809]
Dr. Kelly Fitzgerald explains current standards of care for metastatic hormone-sensitive prostate cancer, focusing on treatment strategies shaped by both clinical trial data and emerging imaging technologies. She defines key terms such as poly- and oligometastatic disease and outlines how newer imaging methods like PSMA PET scans are reshaping diagnosis. She describes the shift from traditional androgen deprivation therapy (ADT) to intensified ADT, where additional agents—such as chemotherapy or novel hormone therapies—are shown to improve survival. Fitzgerald also reviews ongoing questions around triplet therapy and the potential benefits of local treatments like radiation. She highlights the importance of patient-specific factors and the evolving definitions that influence treatment decisions in this complex disease landscape. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40809]
Dr. Kelly Fitzgerald explains current standards of care for metastatic hormone-sensitive prostate cancer, focusing on treatment strategies shaped by both clinical trial data and emerging imaging technologies. She defines key terms such as poly- and oligometastatic disease and outlines how newer imaging methods like PSMA PET scans are reshaping diagnosis. She describes the shift from traditional androgen deprivation therapy (ADT) to intensified ADT, where additional agents—such as chemotherapy or novel hormone therapies—are shown to improve survival. Fitzgerald also reviews ongoing questions around triplet therapy and the potential benefits of local treatments like radiation. She highlights the importance of patient-specific factors and the evolving definitions that influence treatment decisions in this complex disease landscape. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40809]
Those two gigantic PSMA review papers in European Urology - Perera et al 2016 and Perera et al 2020 - have been cited more than 2000 times and have been the definitive reference for anyone writing about PSMA PET/CT in the past ten years. And they have just been updated in two new papers just published in European Urology! Previous first author (Marlon) Perera, has moved to senior author, while Elio Mazzone has led both papers as first author, co-ordinating a massive effort between research teams in Melbourne and Milano. One paper is focused on diagnosis and staging, and the other on assessment of recurrence. GU Cast co-Hosts Declan Murphy and Renu Eapen are joined from Milano by Elio Mazzoni and Alberto Briganti, and in studio by Marlon Perera, to summarise some of the key findings, and describe the immense effort which went into these papers. Worthy successors to the Perera et al papers of the past! Even better on our YouTube channelLinks:Paper 1: PSMA PET/CT for diagnosis and staging Paper 2: PSMA PET/CT for recurrence
Dr. Thomas Hope presents PSMA PET imaging as a transformative advancement in prostate cancer care. This technology uses a radioactive tracer to precisely detect cancer spread by targeting PSMA, a protein found on prostate cancer cells. It outperforms traditional bone and CT scans in sensitivity and accuracy, allowing for better staging and treatment planning. PSMA PET improves radiation therapy outcomes by revealing cancer in areas previously undetected. While multiple tracers exist, all FDA-approved options show similar performance, and accessibility is the key factor. Hope also discusses current challenges, including false positives and rare cases of PSMA-negative tumors. Ongoing research explores replacing biopsy or MRI with PSMA PET in select patients. Today, PSMA PET is considered the standard imaging method in nearly all stages of prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40806]
Dr. Thomas Hope presents PSMA PET imaging as a transformative advancement in prostate cancer care. This technology uses a radioactive tracer to precisely detect cancer spread by targeting PSMA, a protein found on prostate cancer cells. It outperforms traditional bone and CT scans in sensitivity and accuracy, allowing for better staging and treatment planning. PSMA PET improves radiation therapy outcomes by revealing cancer in areas previously undetected. While multiple tracers exist, all FDA-approved options show similar performance, and accessibility is the key factor. Hope also discusses current challenges, including false positives and rare cases of PSMA-negative tumors. Ongoing research explores replacing biopsy or MRI with PSMA PET in select patients. Today, PSMA PET is considered the standard imaging method in nearly all stages of prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40806]
Dr. Thomas Hope presents PSMA PET imaging as a transformative advancement in prostate cancer care. This technology uses a radioactive tracer to precisely detect cancer spread by targeting PSMA, a protein found on prostate cancer cells. It outperforms traditional bone and CT scans in sensitivity and accuracy, allowing for better staging and treatment planning. PSMA PET improves radiation therapy outcomes by revealing cancer in areas previously undetected. While multiple tracers exist, all FDA-approved options show similar performance, and accessibility is the key factor. Hope also discusses current challenges, including false positives and rare cases of PSMA-negative tumors. Ongoing research explores replacing biopsy or MRI with PSMA PET in select patients. Today, PSMA PET is considered the standard imaging method in nearly all stages of prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40806]
Dr. Thomas Hope presents PSMA PET imaging as a transformative advancement in prostate cancer care. This technology uses a radioactive tracer to precisely detect cancer spread by targeting PSMA, a protein found on prostate cancer cells. It outperforms traditional bone and CT scans in sensitivity and accuracy, allowing for better staging and treatment planning. PSMA PET improves radiation therapy outcomes by revealing cancer in areas previously undetected. While multiple tracers exist, all FDA-approved options show similar performance, and accessibility is the key factor. Hope also discusses current challenges, including false positives and rare cases of PSMA-negative tumors. Ongoing research explores replacing biopsy or MRI with PSMA PET in select patients. Today, PSMA PET is considered the standard imaging method in nearly all stages of prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40806]
A beachside interview with Michael Hofman to hear all the PSMA theranostic highlights at ASCO this year! Yes we left our suburban studio in Melbourne and wandered down to St Kilda beach to track down Michael for a beer and a chat. Even in mid-Winter we enjoyed sitting out in a beachside shack at the Beachcomber Cafe and Beach Bar. Michael shot some great interviews in Chicago with top clinicians in Nuclear Medicine including Bastiaan Privé, Louise Emmet, Jeremie Calais, Urologist Alberto Briganti, and Medical Oncologist Rana McKay. Great multidisciplinary perspectives on the Bullseye trial, Violet, Enza-P plus much more. Including a chat about the great promise of CAIX in renal cancer. With your usual hosts, Renu Eapen and Declan MurphyEnjoy the beachside chat even more on our YouTube channel GU Cast Conference Highlights are supported by our Gold Partners, Bayer China. Links:Beachside Bar, St Kilda
For serious PSMA theranostics enthusiasts!!! We bring you the ninth of our collaborative PSMA webinars over the past five years, in collaboration with our team at ProsTIC and at the Prostate Cancer Foundation in the US. A truly outstanding faculty presenting today including Misha Beltran, Marty Pomper, Ed Kwan and Louise Emmett.Co-hosted by Declan Murphy and Michael Hofman with a welcome from Howard Soule and Andrea Miyahira. Declan and Michael are joined in studio by Louise Kostos who helps field the many questions from the huge global audience who joined us live. Much better appreciated on our YouTube channel where you can see all the presentations
Marie Curie's life work laid the foundations for theranostics. This week, we talk about Lutetium, a rare earth metal, and its role in Prostate Cancer. Lutetium-177 PSMA therapy is a radiation therapy that targets prostate cancer. It is used in the advanced, metastatic, and castrate-resistant space. Lutetium is bound to a protein called PSMA. PSMA is overexpressed in many prostate cancers and can be used to target these cancer cells via the membrane antigen.Studies discussed in the episode:UpFrontPSMAVISION trial (and a bit on TheraP)For more episodes, resources and blog posts, visit www.inquisitiveonc.comPlease find us on Twitter @InquisitiveOnc!If you want us to look at a specific trial or subject, email us at inquisitiveonc@gmail.comArt courtesy of Taryn SilverMusic courtesy of AlisiaBeats: https://pixabay.com/users/alisiabeats-39461785/Disclaimer: This podcast is for educational purposes only. If you are unwell, seek medical advice.Oncology for the Inquisitive Mind is recorded with the support of education grants from our foundation partners Pfizer, Gilead Pharmaceuticals and Merck Pharmaceuticals. Our partners have access to the episode at the same time you do and have no editorial control over the content. Hosted on Acast. See acast.com/privacy for more information.
Dr. Rohan Garje shares the updated recommendations for the ASCO guideline on systemic therapy for patients with metastatic castration-resistant prostate cancer. He discusses the systemic therapy options for patients based on prior therapy received in the castration-sensitive and non-metastatic castration-resistant settings. He emphasizes personalizing treatment choices for each individual, considering patient-specific symptoms and signs, treatment-related toxicities, potential drug interactions, cost, and access. He also reviews recommendations on response assessment. The conversation wraps up with a discussion of potential future updates to this guideline, as the guideline transitions into a “living guideline” on mCRPC. Read the full guideline update, “Systemic Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer: ASCO Guideline Update”. Transcript This guideline, clinical tools, and resources are available at www.asco.org/genitourinary-cancer-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology. Brittany Harvey: Hello and welcome to the ASCO Guidelines Podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges and advances in oncology. You can find all the shows, including this one at asco.org/podcasts. My name is Brittany Harvey and today I'm interviewing Dr. Rohan Garje from Miami Cancer Institute Baptist Health South Florida, lead author on, “Systemic Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer: ASCO Guideline Update.” Thank you for being here today, Dr. Garje. Dr. Rohan Garje: Absolutely. Thank you so much for having me, Brittany. Brittany Harvey: And then before we discuss this guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO Conflict of Interest Policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Garje, who has joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. So then, to start on the content of this guideline, first, could you provide us an overview of the purpose of this guideline update? Dr. Rohan Garje: Sure. So ASCO has guidelines for prostate cancer and the specific guideline which we have updated for metastatic castrate-resistant prostate cancer was originally published in 2014. It's almost a decade. It's been a long time due for an update. Over the last decade, we have seen a lot of advances in the treatment of prostate cancer, specifically with regards to genomic testing, newer imaging modalities, and also the treatment landscape. Now we have newer options based on genomic targets such as PARP inhibitors, we have radiopharmaceuticals, a newer variant of chemotherapy, and also some specific indications for immunotherapy which were not addressed previously. Because all these advances have been new, it was really important for us to make an update. In 2022, we did make a rapid update with lutetium-177, but these additional changes which we have seen made it an appropriate time frame for us to proceed with a newer guideline. Brittany Harvey: Absolutely. It's great to hear about all these advances in the field to provide new options. So I'd like to next review the key recommendations from this guideline. So let's start with the overarching principles of practice that the panel outlined. What are these key principles? Dr. Rohan Garje: As a group, all the panel members came up with some ground rules: What are necessary for all our patients who are being treated for metastatic CRPC? First, the founding aspect was a definition for what is metastatic CRPC. So we defined metastatic CRPC as castrate level of testosterone with evidence of either new or progressive metastatic disease on radiological assessments or patients who have two consecutive rising PSAs in the setting of existing metastatic disease. We also emphasized on the need for germline and somatic testing for patients with metastatic prostate cancer at an earliest available opportunity because it is critical to select appropriate treatment and also right treatment for patients at the right time. And we actually have a concurrent guideline which addresses what genes to be tested and the timing. The other principles are patients should continue to receive androgen deprivation therapy or undergo surgical castration to maintain castrate level of testosterone. Now the key aspect with these guidelines is personalizing treatment choices. As you can see the evolution of treatment options for prostate cancer, the drugs that were initially developed and approved for prostate cancer were primarily in castrate-resistant settings, but now most of these drugs are being utilized in castrate-sensitive. So, when these patients develop castration resistance, the challenges are there are no appropriate particular drug-specific guidelines they meet. So, it's very important for the clinicians to be aware of what treatments have been received so far prior to castration resistance so that they can tailor the treatment to patient specific situations. In addition, prior to choosing a therapy, it is important for the physicians to consider patient specific symptoms or signs, treatment-related toxicities, potential drug interactions, cost, and also access to the drugs. There may be multiple treatment options available for the patients, but for a patient specific scenario, there may be a drug that may be more promising than the others. So, it is important to tailor the drug choices based on patients' unique circumstances. The panel also recommends to early integrate palliative and supportive care teams for symptom management and also discuss goals of care with the patient as each patient may have unique needs and it's important for physicians to address those concerns upfront in the care. The panel also suggests patients to receive RANK ligand inhibitors such as denosumab or bisphosphonates such as zoledronic acid to maintain the bone strength to prevent skeletal-related events. Finally, I would like to also emphasize this point about the lack of randomized clinical trial data for optimal sequencing of therapies for patients with metastatic CRPC. As I previously alluded, we have taken into account all ongoing clinical trials, prior published data, and came up with a format of preferred drugs based on prior treatments and, I think, by following these several clinical principles which I just mentioned, we can optimally choose and utilize best treatments for patients with metastatic CRPC. Brittany Harvey: Absolutely. These principles that you just outlined are important for optimal patient care, and then I want to touch on one of those things. You talked importantly about the treatments received so far. So in the next set of recommendations, the role of systemic therapy was stratified by the prior therapy received in the castration-sensitive and non-metastatic castration-resistant setting. So starting with what does the panel recommend for patients who are previously treated with androgen deprivation therapy alone in these previous settings and whose disease has now progressed to metastatic castration-resistant prostate cancer? Dr. Rohan Garje: There are multiple treatment options based on prior treatment received. So for patients who received only ADT for their castration-sensitive disease, the panel strongly urges to get HRR testing to check for homologous recombinant repair related changes, specifically for BRCA1 and BRCA2 mutations, because we have three studies which have really shown significant clinical benefit for patients who have BRCA1 and BRCA2 mutations with drugs such as the combination of talazoparib and enzalutamide or olaparib with abiraterone or niraparib with abiraterone. Unless we test for those mutations, we'll not be able to give these agents upfront for the patients. In the HRR testing, if patients have HRR alterations but they are in genes which are non-BRCA, the guideline panel recommends to utilize talazoparib and enzalutamide based combination therapies. Now, if they don't have HRR alterations then there are multiple treatment choices available. It could either include androgen receptor pathway inhibitors such as abiraterone with prednisone. We could also consider docetaxel chemotherapy. The alternate choices for androgen receptor pathways include enzalutamide or the newer agents such as apalutamide and docetaxel. So, as you can see there are multiple options available, but the panel definitely emphasizes to test for HRR testing because this gives patients access to more precision therapies at this point. There may be various scenarios where a unique drug may be available for a specific patient situation. For example, patients who have very limited disease burden and may have one or two metastatic lesions, after a multidisciplinary discussion, targeted local therapies such as radiation or potentially surgery could also be offered. In select patients who have very indolent disease where they are castrate-resistant based on slow rising PSA, low-volume disease or asymptomatic disease can consider sipuleucel-T. And in patients who have bone-only metastatic disease, we could also consider radium-223, which is primarily now utilized for patients who have symptomatic bone disease. Brittany Harvey: Great. I appreciate you reviewing all those options and talking about how important it is to tailor treatment to the individual patient. So then the next category of patients, what is recommended for those who have been previously treated with ADT and an androgen receptor pathway inhibitor and whose disease has now progressed to metastatic castration-resistant prostate cancer? Dr. Rohan Garje: So for patients who received ADT along with an androgen receptor pathway inhibitor, which we consider would be a most common cohort because most patients now in castration-sensitive setting are receiving androgen receptor pathway inhibitor. It was different in the past where five or six years back ADT alone was the most common treatment, but fortunately, with enough awareness and education, treatment choices have improved. Patients are now receiving ADT and ARPI as the most common choice of drug. Once again, at this point the panel emphasizes to consider HRR testing in there is enough data for us to suggest that patients who have alterations in the HRR pathway definitely will benefit with the PARP inhibitor. You know the multiple options, but specifically we speak about olaparib. And then if they are HRR-negative, we prefer patients receive agents such as docetaxel or if they are intolerant to docetaxel, consider cabazitaxel chemotherapy, options such as radium-223, and if they have a specific scenario such as MSI-high or mismatch repair deficiency, pembrolizumab could also be considered. The panel also discussed about the role of a second ARPI agent. For example, if patients progressed on one androgen receptor pathway inhibitor, the second androgen receptor pathway inhibitor may not be effective and the panel suggests to utilize alternate options before considering androgen receptor pathway inhibitor. There may be specific scenarios where a second ARPI may be meaningful, specifically, if alternate choices are not feasible for the concern of side effects or toxicities or lack of access, then a potential ARPI could be considered after progression on ARPI, but the panel definitely encourages to utilize alternate options first. Brittany Harvey: Great. Thank you for outlining those options as well for those patients. So then the next category, what is recommended for patients who have been previously treated with ADT and docetaxel? Dr. Rohan Garje: For patients who received ADT and docetaxel and were never treated with androgen receptor pathway inhibitors, the panel again emphasizes on HRR testing. If they have BRCA1 and 2 mutations, the combination therapies of talazoparib with enzalutamide, olaparib with abiraterone, or niraparib with abiraterone are all good choices. If they don't have BRCA mutations but they have other HRR mutations, the panel suggests to potentially utilize talazoparib with enzalutamide. And if they do not have any HRR alterations, the options could include androgen receptor pathway inhibitors such as abiraterone or enzalutamide. I want to emphasize that these are preferred options, but not the only options. As you can see, there are multiple options available for a particular clinical situation - so the ability of the physicians to access particular combinations, the familiarity of those drugs or the patient's unique situation where they have other medications which can potentially interact with a choice of agents. So I think based on access, based on cost and patients' concurrent illness with potential drug interactions can make one particular combination of therapy better over the other options. Brittany Harvey: Absolutely. That's key to keep in mind that access, contraindications, and cost all play a role here. So then the next set of recommendations. What are the key recommendations for patients who have previously been treated with ADT, an androgen receptor pathway inhibitor, and docetaxel who now have mCRPC? Dr. Rohan Garje: Yes. In this group, the options remain, again, broad. We utilize PSMA imaging here specifically and if they are positive on PSMA imaging, lutetium-177 is a good option. If they do not have PSMA-positive disease on PSMA imaging but if they have HRR alterations, olaparib could be utilized. And if they are negative on PSA imaging, they don't have HRR alterations, then alternate options could include cabazitaxel, radium-223. And if they have MSI-high or deficiency in mismatch repair, pembrolizumab could be utilized in this setting. Brittany Harvey: Thank you for outlining those options as well. So then next the panel addressed treatment options for de novo or treatment emergent small cell neuroendocrine carcinoma of the prostate. What are those key recommendations? Dr. Rohan Garje: Yes. This is a very high unmet need group because there are limited clinical trials, especially prospective clinical trials addressing treatment options for this group. Most of our current guidelines are always an extrapolation from lung small cell cancer based guidelines, but the panel recommends to utilize cisplatin or carboplatin along with etoposide as a preferred choice for this group. Also, an alternate option of carboplatin along with cabazitaxel could be considered for this cohort. The panel also encourages participation in clinical trials. There are numerous trials ongoing now in smaller phase studies and I think it's important for patients to consider these trials as well, because this will give them access to newer agents with potential biological targets. In addition to these agents in specific scenarios or potentially case by case basis, because we don't have prospective data, so we have made it as a select case by case basis to consider adding immunotherapy along with platinum-based chemotherapy followed by maintenance immunotherapy, which is currently a standard of care in small cell lung cancer. But the data is so limited in prostate cancer, so the panel suggested that it has to be a case by case basis only. The alternate options also include lurbinectedin, topotecan, tarlatamab upon progression on platinum-based chemotherapy. Brittany Harvey: Yes. It's important to have these recommendations in these unique situations where there is really a lack of data. So then the final set of recommendations I'd like to cover, what does the panel recommend for how clinicians should assess for response while patients are on systemic therapy and what scans are recommended for this response assessment? Dr. Rohan Garje: Yes. Again, this is another strong emphasis of the panel for global assessment of the patients. Traditionally, patients and physicians per se are heavily reliant on PSA as an accurate marker for response. This is in fact true in earlier phases of prostate cancer either in castrate-sensitive setting or localized prostate cancer setting. But as patients evolve into castrate-resistant, we don't want to heavily rely on PSA alone as a marker of response. The panel suggests to incorporate clinical response, radiological response, and also include PSA as a component, but not just rely primarily on PSA. So the panel also suggests that patients should get a bone scan and a CT scan every three to six months while on treatment to assess for appropriate response or for progression. And now one key important aspect, we are all aware about the evolving role of PSMA-based imaging with several of these new agents that are currently available. We do acknowledge these scans definitely have an important role in the care for patients with metastatic prostate cancer. Currently, the utility is primarily to select patients for lutetium-based therapy and also in situations where the traditional scans such as technitium 99 bone scan or CT scan are equivocal, then a PSMA-based imaging can be helpful. Now we are also aware that there are newer studies coming up, prospective data coming up for the role of PSMA-based imaging for response assessment. We are hoping to update the guidelines if we get access to newer data, but currently we have not recommended the utility of PSMA-based imaging for response assessments. Brittany Harvey: Understood. And I appreciate you describing where there is data here and where there's a lack of data to currently recommend. And we'll look forward to future updates of this guideline. Coming back to – at the start you mentioned how much has changed since the last guideline update. So Dr. Garje, in your view, what is the importance of this update and how will it impact both clinicians and patients with metastatic castration-resistant prostate cancer? Dr. Rohan Garje: The updated guidelines are designed to have a significant impact on clinical practice and also patient outcomes by providing clinicians with a comprehensive evidence-based framework for managing patients with metastatic CRPC. And also, by using these guidelines can make informed decisions, can select therapies tailored to patients' unique genomic status, clinical situation, where they are in the course of the cancer based on what they received previously. Also utilizing these guidelines, we can potentially improve patient outcomes, improve survival, and importantly have efficient use of healthcare resources. Brittany Harvey: Absolutely. We're always looking for ways to improve patient outcomes and survival. I want to wrap us up by talking a little bit about the outstanding questions in this field. So earlier you had mentioned about prospective data to come about PSMA PET scans, but what other outstanding questions are there for patients with metastatic castration-resistant prostate cancer? And what evidence is the panel looking forward to for future updates? Dr. Rohan Garje: We do have now rapidly evolving data specifically about the utility of the radiopharmaceutical lutetium-177 prior to chemotherapy. We are hoping that with newer data we can make some changes to the guideline based on that. We are also looking at newer drugs that are coming up in the pipeline, for example, androgen receptor degraders. We are looking at data that might potentially help based on bispecific T-cell engagers and newer radiopharmaceuticals. So I think in the next few years, we will definitely update all the guidelines again. But this time we are trying to do it more proactively. We are following a newer model. We are calling it as ‘living guidelines' where we are actually utilizing week by week updates where we look at the literature and see if there is any potential practice impacting change or publication that comes up. And we are trying to incorporate those changes as soon as they are available. That way patients and practicing physicians can get the latest information available through the guidelines as well. Brittany Harvey: That's great to hear. Yes, we'll await this data that you mentioned to continuously update this guideline and continue to improve patient outcomes for the future. So Dr. Garje, I want to thank you so much for your time to update this guideline. It was certainly a large amount of recommendations, and thank you for your time today, too. Dr. Rohan Garje: Thank you so much for having me here. And it's always nice talking to you. Brittany Harvey: And finally, thank you to our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/genitourinary-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app, which is available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.
In this episode of the Dr. Geo Prostate Podcast, Dr. Geo welcomes Dr. Alberto Vargas, Vice Chair of Oncologic Imaging at NYU Langone Health and expert in prostate cancer imaging.They dive deep into the evolving world of diagnostic tools—MRI, PET, CT, and PSMA scans—and how these technologies help detect, monitor, and guide treatment for prostate cancer. Dr. Vargas explains the difference between imaging modalities, when to use them, and how PSMA PET scans are changing the game in identifying recurrent and metastatic disease earlier than ever before.Key topics covered:MRI vs. PET vs. CT: what each scan shows and when it matters mostThe rise of PSMA PET for finding prostate cancer at extremely low PSA levelsWhy not all PET scans are the same, and how tracers like FDG, Axumin, and PSMA workThe potential future of prostate cancer diagnosis: fewer biopsies, more imagingLimitations, false positives, and how imaging results are interpretedThe role of imaging in both first-time diagnosis and recurrenceWhether you're a patient, caregiver, or clinician, this episode offers valuable insight into how imaging helps guide smart, proactive decisions in prostate cancer care.----------------Thank you to our partnersThe ProLon 5-Day Fasting Mimicking Diet is a plant-based meal program designed to provide fasting benefits while allowing food intake. Developed by Dr. Valter Longo, it supports cellular renewal, fat loss, and metabolic health through low-calorie, pre-packaged meals that maintain the body in a fasting state.Special Offer: Thank you for listening, you can purchase the ProLon kit for just $148 by using this link.We'd also like to thank our partner AG1 by Athletic Greens. AG1 contains 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, nervous system, immune system, energy, recovery, focus, and aging. All the essentials in one scoop. Enjoy AG1 by Athletic Greens.----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook, Instagram Click here to become a member of Dr. Geo's Health Community.Improve your urological health with Dr. Geo's formulated supplement lines:XY Wellness for Prostate cancer lifestyle and nutrition: Mr. Happy Nutraceutical Supplements for prostate health and male optimal living.You can also check out Dr. Geo's online dispensary for other supplement recommendations Dr. Geo's Supplement...
Elena Castro joins Tom and Brian on the day after Pluvicto approval pre-chemotherapy in the US to discuss the PSMA Fore data and application in clinical practice.
In this episode of the Dr. Geo Prostate Podcast, Dr. Geo welcomes Dr. Alberto Vargas, Vice Chair of Oncologic Imaging at NYU Langone Health and expert in prostate cancer imaging.They dive deep into the evolving world of diagnostic tools—MRI, PET, CT, and PSMA scans—and how these technologies help detect, monitor, and guide treatment for prostate cancer. Dr. Vargas explains the difference between imaging modalities, when to use them, and how PSMA PET scans are changing the game in identifying recurrent and metastatic disease earlier than ever before.Key topics covered:MRI vs. PET vs. CT: what each scan shows and when it matters mostThe rise of PSMA PET for finding prostate cancer at extremely low PSA levelsWhy not all PET scans are the same, and how tracers like FDG, Axumin, and PSMA workThe potential future of prostate cancer diagnosis: fewer biopsies, more imagingLimitations, false positives, and how imaging results are interpretedThe role of imaging in both first-time diagnosis and recurrenceWhether you're a patient, caregiver, or clinician, this episode offers valuable insight into how imaging helps guide smart, proactive decisions in prostate cancer care.----------------Thank you to our partnersThe ProLon 5-Day Fasting Mimicking Diet is a plant-based meal program designed to provide fasting benefits while allowing food intake. Developed by Dr. Valter Longo, it supports cellular renewal, fat loss, and metabolic health through low-calorie, pre-packaged meals that maintain the body in a fasting state.Special Offer: Thank you for listening, you can purchase the ProLon kit for just $148 by using this link.We'd also like to thank our partner AG1 by Athletic Greens. AG1 contains 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, nervous system, immune system, energy, recovery, focus, and aging. All the essentials in one scoop. Enjoy AG1 by Athletic Greens.----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook, Instagram Click here to become a member of Dr. Geo's Health Community.Improve your urological health with Dr. Geo's formulated supplement lines:XY Wellness for Prostate cancer lifestyle and nutrition: Mr. Happy Nutraceutical Supplements for prostate health and male optimal living.You can also check out Dr. Geo's online dispensary for other supplement recommendations
Dr. Sue Yom, Editor in Chief, hosts guests Dr. Cristian Udovicich, a Fellow in Radiation Oncology at the University of Toronto's Sunnybrook Odette Cancer Centre, and Dr. Angela Jia, Assistant Professor and Assistant Residency Program Director at University Hospitals Cleveland Medical Center, who were the first and second authors of "Evolving Paradigms in Prostate Cancer: The Integral Role of Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography in Primary Staging and Therapeutic Decision-Making." In addition, we review long-term SBRT results with Dr. Andrew Loblaw, Full Professor in the Department of Radiation Oncology and Institute of Health Policy, Management and Evaluation at Sunnybrook Health Science Center at the University of Toronto and supervising author of "Stereotactic Radiation Therapy for Localized Prostate Cancer: 10-Year Outcomes From Three Prospective Trials," and Dr. Constantinos Zamboglou, Deputy Medical Director at the German Oncology Center in Limassol, Cyprus and first author of an accompanying editorial, "Stereotactic Body Radiotherapy for Prostate Cancer is Getting Mature: 10-Year Outcomes From Three Prospective Trials."
In this two-part episode of the Precision Medicine Podcast, host Karan Cushman continues her deep dive into prostate cancer care with expert guest Dr. William Oh, a leading genitourinary oncologist, Director of Precision Medicine at Yale Cancer Center and Chair of the American Cancer Society National Prostate Cancer Roundtable. Building on part one (episode 63), they explore the transformative role of precision medicine, advanced diagnostics, and targeted therapies—emphasizing the urgent need for greater awareness, understanding, and advocacy as prostate cancer continues to rise steadily. Karan opens the conversation by emphasizing the growing complexity of prostate cancer diagnostics and treatment. Dr. Oh discusses the wide array of diagnostic tools, from PSA tests and MRIs to the cutting-edge PSMA PET scan, which has revolutionized staging and treatment planning by providing detailed insights into cancer spread. He highlights how these tools are helping oncologists tailor treatment plans with unprecedented precision. The discussion shifts to molecular diagnostics, a burgeoning field that provides critical information about the aggressiveness of cancer. Dr. Oh explains how molecular tests, such as genomic profiling, are enabling personalized treatment decisions for prostate cancer patients, particularly those on the fence about options like surgery, radiation, or active surveillance. Karan and Dr. Oh also address disparities in access to these advanced diagnostics, underlining the need for wider implementation. Karan steers the conversation toward advancements in targeted therapies. Dr. Oh outlines breakthroughs in precision treatments, including PARP inhibitors for patients with BRCA mutations and the innovative LU-177-PSMA therapy, a “smart bomb” approach that targets cancer cells with remarkable specificity. He also explores the promise of immunotherapy, though he acknowledges its limited applicability for prostate cancer due to the disease's low mutational burden. The role of artificial intelligence in precision oncology is another key topic. Dr. Oh and Karan discuss how AI and machine learning are helping clinicians process complex data, from imaging to genomic profiles, to guide more informed treatment decisions. Dr. Oh envisions AI as an essential tool for streamlining oncology workflows while preserving the human connection between doctors and patients. Karan highlights the importance of effective communication in prostate cancer care, referencing a recent editorial co-authored by Dr. Oh. Together, they explore the need for more patient-centered terminology, such as replacing the term “castration-resistant prostate cancer” with “androgen deprivation-resistant prostate cancer,” to foster better understanding and improve patient experience. The episode concludes with a forward-looking discussion on clinical trials, the integration of new technologies like liquid biopsies, and the ongoing efforts to expand insurance coverage for biomarker testing. Dr. Oh emphasizes the critical role of collaboration, awareness, and education in advancing precision medicine and ensuring that patients benefit from the latest innovations. With Karan's thoughtful questions and Dr. Oh's expertise, this episode offers a comprehensive and accessible exploration of how precision medicine is reshaping the future of prostate cancer care. We hope you'll tune in to the series and share this important episode with others!
Dr. Ashwin Singh Parihar speaks with Dr. Phillip Kuo, Dr. Andrew Armstrong, and Dr. Ken Herrmann about how 68Ga-PSMA-11 PET can predict response of metastatic prostate cancer following 177Lu-PSMA-617 therapy. The VISION Trial. Quantitative 68Ga-PSMA-11 PET and ClinicalOutcomes in Metastatic Castration-resistant ProstateCancer Following 177Lu-PSMA-617 (VISION Trial). Kuo and Morris et al. Radiology 2024; 312(2):e233460.
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