The field of genitourinary (GU) cancers is starting to undergo some of the same changes that have been shifting treatment paradigms so dramatically in other malignancies. The most significant change can be summed up in one word: immunotherapy.
In early February, the FDA moved in rapid succession to approve the PD-1 checkpoint blockade immunotherapy agent nivolumab (Opdivo) for the treatment of patients with metastatic urothelial carcinoma (mUC) after prior therapy and the agency is also considering pembrolizumab (Keytruda), which has the same mechanism of action, for 2 mUC indications under its priority review program. These actions come just months after the May 2016 approval of atezolizumab (Tecentriq), a PD-L1 inhibitor, for patients with mUC.
In short order, then, the armamentarium for treating patients with the most common form of bladder cancer went from a eld where not much had changed for several decades to one pulsing with fresh promise.
This issue of Urologists in Cancer Care® contains full reports of these exciting developments. The good news, however, goes beyond bladder cancer. Our cover story, titled “First-Ever SITC Guidelines in RCC Address Continuing Role of Interluekin-2 and Emergence of Nivolumab,” discusses current evidence-based use of immunotherapies in another GU malignancy.
Immunotherapy also may make an impact metastatic castration-resistant prostate cancer (mCRPC). A phase II study showed that the addition of pembrolizumab to enzalutamide (Xtandi) in patients with mCRPC progressing on the androgen receptor (AR)–directed therapy may be associated with durable responses. In an interview with Dana E. Rathkopf, MD, we learn a great deal about this study, as well as why it is so essential to understand AR resistance in patients with prostate cancer. “Our eld is running to catch up and gure out who is the best patient to get AR-targeted agents and what the mechanisms of resistance are,” said Rathkopf. “Perhaps we can do combinations with chemotherapy, immunotherapy, or DNA mismatch-repair agents. It’s a very exciting time for the eld.”
Despite these positive developments, there is a potentially concerning recent event. Sano will be discontinuing production of Bacillus Calmette-Guérin (BCG) for the US market mid-2017, leaving Merck as the only producer of the vaccine. Merck says it can meet the demand. We certainly hope that turns out to be the case.
As we move forward this year, we will be keeping you posted about all of these developments. As always, thank you for reading.