Adam C. Reese, MD
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. Some urologists are still on the fence about these agents, some prefer to leave immuno-oncology (I/O) in the hands of the medical oncologist, and others have fully embraced I/O agents and advocate that urologists start prescribing them.
Whether to move I/O treatment squarely into the urology clinic has been a hot topic at recent conferences. “The reason this has been getting a lot of attention is that urologists over the past decade have been very successful in treating metastatic castrate-resistant prostate cancer [CRPC],” said Raoul S. Concepcion, MD, FACS, editor-in-chief of Urologists in Cancer Care (UCC) and director of The Comprehensive Prostate Center in Nashville, Tennessee. Concepcion firmly believes that I/O administration can be managed by urology clinics.
On the other side of the argument is Adam C. Reese, MD, associate professor of urology at the Lewis Katz School of Medicine and chief of urologic oncology at Temple University Hospital, both in Philadelphia, Pennsylvania, who does not prescribe I/O in his practice. The use of I/O, as well as chemotherapy, is not part of the standard training for urologists, and Reese does not feel sufficiently knowledgeable about or comfortable prescribing these agents.
“I’m totally in favor of the new immunotherapies when indicated,” Reese said. “I just prefer to send patients to somebody who prescribes a lot of these therapies, is comfortable with [I/O], and has a greater understanding of the indications and the potential AEs [adverse effects] and how to manage them.”
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