Genitourinary Cancers

The European Medicines Agency's Committee for Medicinal Products for Human Use has recommended approval of pembrolizumab (Keytruda) in combination with axitinib (Inlyta) for the frontline treatment of patients with advanced renal cell carcinoma.

Erdafitinib induced an objective response rate of 40% in previously treated patients with locally advanced or metastatic urothelial carcinoma, according to findings from the pivotal phase II BLC2001 trial published in the New England Journal of Medicine.

Sumanta Kumar Pal, MD, an associate clinical professor, Department of Medical Oncology & Therapeutics Research, co-director, Kidney Cancer Program, and medical oncologist at City of Hope, discusses the design of the phase II SWOG 1500 trial (NCT02761057) in locally advanced or metastatic papillary renal cell carcinoma (RCC).

Claud M. Grigg Jr, MD, highlights data from pivotal trials with combinations in both clear cell and non-clear cell renal cell carcinoma, as well as challenges with identifying biomarkers for immunotherapy.

In the phase III PROSPER trial, investigators will attempt a novel approach in localized renal cell carcinoma: priming the immune system prior to nephrectomy with neoadjuvant nivolumab and continuing with adjuvant blockade. The study will be the first to combine neoadjuvant and adjuvant immunotherapy with standard of care nephrectomy.

A biologics license application has been submitted to the FDA for enfortumab vedotin for the treatment of patients with locally advanced or metastatic urothelial cancer who have previously received a PD-1/PD-L1 inhibitor and who have received a platinum-containing chemotherapy in the neoadjuvant/adjuvant, locally advanced, or metastatic setting.

Toni Choueiri, MD, director, Lank Center for Genitourinary Oncology, director, Kidney Cancer Center, senior physician, Dana-Farber Cancer Institute, and Jerome and Nancy Kohlberg Chair and professor of medicine, Harvard Medical School, discusses the next generation of trials in renal cell carcinoma (RCC).

Robert Dreicer, MD, highlights the current state of immunotherapy in urothelial cancer and ongoing research poised to offer more information on how to broaden its effects.

Toni Choueiri, MD, discusses the use of checkpoint inhibitors to treat patients with sarcomatoid carcinoma.

Brian M. Shuch, MD, director, Kidney Cancer Program, Alvin & Carrie Meinhardt Endowed Chair in Kidney Cancer Research, University of California, Los Angeles Institute of Urologic Oncology, discusses the impact of the phase III SURTIME study in advanced renal cell carcinoma (RCC).

Toni Choueiri, MD, director, Lank Center for Genitourinary Oncology, director, Kidney Cancer Center, senior physician, Dana-Farber Cancer Institute, and Jerome and Nancy Kohlberg Chair and professor of medicine, Harvard Medical School, discusses the frontline combination therapies that are available for the treatment of patients with metastatic renal cell carcinoma (mRCC).

Funda Meric-Bernstam, MD, chair of the Department of Investigational Cancer Therapeutics, medical director of the Institute for Personalized Cancer Therapy, and a professor in the Divisions of Cancer Medicine and Surgery at The University of Texas MD Anderson Cancer Center, discusses the activity of the combination of telaglenastat (CB-839) and cabozantinib (Cabometyx) in heavily pretreated patients with metastatic renal cell carcinoma (mRCC).

Investigators see potential in adding targeted therapy to dual immunotherapy for intermediate- and poor-risk patients with renal cell carcinoma. In the phase III COSMIC-313 trial, investigators aim to evaluate cabozantinib, nivolumab, and ipilimumab in patients with untreated advanced RCC.

A novel formulation of the chemotherapy drug mitomycin demonstrated a 59% complete response rate among patients with unresectable low-grade upper tract urothelial cancer, signaling the potential for a minimally invasive alternative to kidney removal for some individuals with this malignancy,

Switch maintenance treatment with pembrolizumab improved progression-free survival in patients with metastatic urothelial cancer who have stable disease following frontline platinum-based chemotherapy.

Use of a cytokine agonist in combination with BCG was highly successful in stimulating an immune response in previously BCG-unresponsive patients with carcinoma in situ high-grade nonmuscle invasive bladder cancer, according to early trial results presented by Sam S. Chang, MD, MBA, at the 2019 American Urological Association Annual Meeting.

Funda Meric-Bernstam, MD, discusses the potential for the combination of telaglenastat (CB-839) and cabozantinib (Cabometyx) in the treatment of metastatic renal cell carcinoma.

As immunotherapy has become increasingly utilized, urologists are more frequently participating in the management of patients who are receiving immunotherapy.

Bradley McGregor, MD, clinical director, Lank Center for Genitourinary Oncology, senior physician, Dana-Farber Cancer Institute, and instructor of medicine, Harvard Medical School, discusses the combination of atezolizumab (Tecentriq) and bevacizumab (Avastin) in renal cell carcinoma (RCC).

The FDA approved indications in urologic cancers for 6 immune checkpoint inhibitors since 2015. That is unquestionably a good thing for patients, but the rise of these agents means that the role of the urologist in cancer care is changing, and some urologists are still on the fence about these agents.

Combining telaglenastat (CB-839) with everolimus (Afinitor) doubled the median progression-free survival versus everolimus alone in heavily pretreated patients with advanced renal cell carcinoma.