Genitourinary Cancers Symposium

GU 2017 Daily News - Friday

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New Drug Development in Urothelial Cancer: An Explosion of Riches? Matthew T. Campbell, MD, MS, and Ashish M. Kamat, MD, MBBS, FACS T he 2017 Genitourinary Cancers Symposium lec- ture covering the state of urothelial carcinoma will thankfully not include a slide that states, "Little to no prog- ress has been made in drug de- velopment since combination chemotherapy circa 1985." In the past year, new, active agents have arrived, heralding a change in the treatment land- scape of metastatic bladder can- cer. Importantly, these agents and others have the potential to affect urothelial cancer in all of its states: metastatic, locally advanced, muscle-invasive, and even noninvasive tumors. These new agents may also help patients who are not eligible for cisplatin-based therapy, who have impaired performance sta- tus, and who otherwise have been excluded from many clini- cal trials. Suddenly, instead of having a patient population of 15,000 patients with unresect- able or metastatic urothelial cancer, the entire urothelial can- cer population—approximately 75,000 Americans per year— may become eligible for the emerging treatments currently being studied. As expected, our partners in the pharmaceutical industry have taken note, and where once urothelial cancer was often felt to be a very chal- lenging space for investigation, the fl oodgates for studies have opened. In this review of drug devel- opment in urothelial carcino- ma, we will highlight the state of immunotherapeutics and targeted therapy and discuss the potential impact of bio- markers and molecular subtyp- ing in personalizing therapy. Molecular Understanding Spurs Drug Discovery Anatomic location and histo- logic grading have historically been the key determinants guid- ing treatment plans for patients with urothelial cancer. Low- grade urothelial cancer of the bladder has a vastly different outcome than high-grade mus- cle-invasive disease. Although transurethral removal of tumors and adjuvant immunotherapy with bacillus Calmette-Guérin Attendee Tip of the Day View captured sessions and posters through Virtual Meeting. Virtual Meeting access is included in the Symposium registration fee. Presentations can be viewed online or downloaded as a podcast. Risk Stratifi cation, Clinical Management, and Late Complications of Chemotherapy for Testicular Cancer L awrence H. Einhorn, MD, FASCO, distinguished professor of medicine at the Indiana University School of Medicine, will discuss management of clinical stage I disease, risk stratifi - cation, and chemotherapy for testicular cancer during his keynote lecture on February 17. He will also provide important insights about salvage therapy for patients not cured with initial chemotherapy and will discuss late complications of platinum- based chemotherapy. Dr. Einhorn is best known for his contribution to one of the greatest achievements in the fi eld of oncology: the introduction of platinum combination therapy for testicular cancer in 1974. His pioneering research on cisplatin resulted in the discovery of an effective cure for testicular cancer that, previously, almost always had fatal outcomes; prior to Dr. Einhorn's breakthrough discovery, approximately 90% of patients with metastatic testicular cancer died within 1 year. 1 Since the fi rst introduction of platinum combination therapy more than 40 years ago, platinum agents have been successfully used as fi rst-line therapy in 12 different malignancies, transforming the oncology fi eld. Dr. Einhorn spent the next few decades refi ning the treatment of testicular cancer—minimizing treatment toxicity and increasing therapeutic effi cacy. In phase III studies, his team demonstrated that reducing the dosage of vinblastine resulted in reduced neuromuscular and hematologic toxicity, eliminating the need for 2 years of maintenance vinblastine. His research also dem- onstrated that substituting etoposide for vinblastine yields higher cure rates and lower toxicity. Genomic Susceptibility to Platinum-Based Chemotherapy Complications In an interview with the Genitourinary Cancers Symposium Daily News, Dr. Einhorn said that 95% of all patients diagnosed with tes- ticular cancer in 2016 will be cured, which includes 80% of patients with metastatic disease. "These latter patients will either be cured with initial chemother- apy or subsequent salvage therapy, which sometimes can include salvage surgery rather than salvage chemotherapy," he said. "Sal- vage chemotherapy with ifosfamide-based chemotherapy or high- dose chemotherapy in peripheral blood stem cell transplant allows realistic probability for cure in [patients with] refractory [disease]." An 80% cure rate for metastatic testicular cancer is substantially higher than the cure rate for any other metastatic disease treat- ed with chemotherapy. Because it would be diffi cult to improve See Keynote Lecture, Page 8 See Urothelial Cancer, Page 3 What's New at the Society of Urologic Oncology 8 Earn MOC Points 10 Urothelial Carcinoma Year in Review Preview 10 Systemic Treatment for Metastatic Non–Clear Cell RCC 12 Symposium Essentials: Networking 16 Managing Hypoxic High-Risk Prostate Cancer 16 My Meeting Experience: A Radiation Oncologist's Perspective 19 Restaurant Recommendations 19 Virtual Mentors Provide Guidance to Junior Faculty 20 Dr. David J. McConkey to Discuss Immunology in Bladder Cancer 22 Symposium Essentials: Stay Connected 24 Incorporating Radiation Oncology Into Immunotherapy 24 Symposium Essentials: Audience P articipation 25 ASCO Launches JCO Precision Oncology 25 INSIDE f f Dr. Lawrence H. Einhorn T A R G E T I N G C A N C E R C A R E The Role of Whole-Body MRI in Prostate Cancer Staging N eha Vapiwala, MD, an- swers a question posed by an attendee during a Best of ASCO ® Meet- ing. Dr. Vapiwala is an associ- ate professor and vice chair of education in the Department of Radiation Oncology at the Uni- versity of Pennsylvania, adviso- ry dean at the Perelman School of Medicine, and senior editor of OncoLink. Question: What is the role of whole-body MRI in prostate cancer staging? Answer: Multiparametric MRI is an established and highly useful tool for both pre-biopsy assessment of suspected pros- tate cancer (i.e., in the setting of an elevated screening PSA level) and post-biopsy locoregional See Whole-Body MRI, Page 10 2017 F R I D A Y, F E B R U A R Y 1 7 O R L A N D O , F L Zach Hetrick ➤ To access Virtual Meeting, visit the Attendee Resource Center (gucasym.org/arc). Clinical Corner

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