Genitourinary Cancers

Immunotherapy is at the forefront of the burgeoning treatment landscape in renal cell carincoma, according to David McDermott, MD.

Laurence Albiges, MD, ‎medical oncologist, head, Genitourinary Oncology Unit, Gustave Roussy, discusses how immunotherapy has had an impact on the field of renal cell carcinoma (RCC).

In a propensity-matched analysis of a national cancer registry, patients who underwent radical cystectomy or concurrent chemoradiation to treat urothelial cancer demonstrated statistically similar median overall survival rates. Further analysis suggests that the hazard ratios between the two treatments change over time and is hypothesis generating.

As the fields of renal cell carcinoma and bladder cancer continue to dramatically progress with the approval of novel agents—both immune-based and targeted therapies—oncologists need to improve their methods of selecting patients to receive such available therapies.

Toni K. Choueiri, MD, clinical director, Lank Center for Genitourinary Oncology, director, Kidney Cancer Center, senior physician, Dana-Farber Cancer Institute, discusses the results of the phase II CABOSUN trial, which compared cabozantinib (Cabometyx) with sunitinib (Sutent) in the frontline setting of patients with metastatic renal cell carcinoma (RCC).

Cabozantinib (Cabometyx) reduced the risk of progression or death by 31% compared with sunitinib (Sutent) in the frontline setting for patients with metastatic renal cell carcinoma.

Early results from a pre-planned interim analysis in the KEYNOTE-052 phase II trial of first-line pembrolizumab in cisplatin-ineligible patients with metastatic urothelial cancer demonstrated antitumor activity and a favorable response rate.

Adjuvant sunitinib prolonged disease-free survival by 1.2 years compared with placebo following nephrectomy for patients with high-risk clear cell renal cell carcinoma.

Safety, efficacy, and biomarker results from the phase II CheckMate-275 trial of the PD-1 inhibitor nivolumab (Opdivo) that support FDA and European Medicines Agency applications were reported at the 2016 ESMO Congress.

In kidney cancer there are three “eras” in the history of treatment advances, said James Hsieh, MD, PhD, medical oncologist, Memorial Sloan Kettering Cancer Center.

Randy F. Sweis, MD, clinical instructor, University of Chicago Medicine, discusses the trend toward immunotherapy in the field of genitourinary malignancies.

Historically, patients with advanced renal cell carcinoma have had few treatment options, but several targeted agents and one immunotherapy, the checkpoint inhibitor nivolumab, have been approved within the past 5 years, considerably expanding the RCC treatment arsenal. In the frontline setting, targeted agents are often the go-to therapy.

Elizabeth Plimack, MD, discusses some of the most impressive advancements with immunotherapy agents in the fields of renal cell carcinoma and bladder cancer, as well as remaining questions with the use of these treatments.

The European Medicines Agency has validated a type II variation application for use of nivolumab (Opdivo) as a treatment for patients with locally advanced unresectable or metastatic urothelial carcinoma who have progressed following platinum-based chemotherapy.

The European Commission has approved lenvatinib (Kisplyx) in combination with everolimus for patients with advanced renal cell carcinoma following 1 prior VEGF-targeted therapy.

The PD-L1 inhibitor atezolizumab has been found to be non-toxic and has demonstrated a major survival advantage in patients with metastatic urothelial bladder cancer.

The European Commission has approved cabozantinib for the treatment of patients with advanced renal cell carcinoma after the failure of VEGF-targeted therapy, according to Exelixis and Ipsen, the manufacturers of the multikinase inhibitor.

The FDA’s Oncologic Drugs Advisory Committee voted 14-0 against approving apaziquone (EOquin; Qapzola) for intravesical instillation immediately following transurethral resection in patients with non-muscle invasive bladder cancer.

Mark A. Rubin, MD, is an expert in prostate cancer genomics and pathology who has led key discoveries in the distinction between indolent and aggressive types of the malignancy.

Mark Ball, MD, chief urology resident, Johns Hopkins University School of Medicine, discusses the eventual role that immunotherapy will play in the treatment landscape of renal cell carcinoma (RCC), as well as patient selection to receive immunotherapy as a single agent or in combination.

Evidence has demonstrated that obesity is a risk factor for clear cell renal cell carcinoma; however, a new report suggests that a high body mass index is a prognostic factor for improved survival in patients with metastatic RCC who have received targeted therapy.

Jorge A. Garcia, MD, discusses the final survival data from the phase III METEOR trial, which was the basis for cabozantinib's (Cabometyx's) FDA approval, as well as the role the agent will now play along with nivolumab (Opdivo) in advanced RCC.

David F. McDermott, MD, director of the Biologic Therapy Program at Beth Israel Deaconess Medical Center, discusses the findings of the phase III CheckMate-025 trial of nivolumab (Opdivo) versus everolimus (Afinitor) in renal cell carcinoma (RCC).

Saeed Rafii, MD, PhD, medical director, Sarah Cannon Research Institute, United Kingdom, discusses novel immunotherapy approaches for the treatment of patients with bladder cancer.

Michael L. Blute, MD, chair of Department of Urology, Massachusetts General Hospital, discusses the differences between kidney-sparing surgery and radical nephrectomy for patients with renal cell carcinoma (RCC).