ESMO 2018 News - Episode 5
Daniel J. George, MD, professor of medicine and surgery, member, Duke Cancer Institute, discusses key abstracts in renal cell carcinoma (RCC) and prostate cancer presented at the 2018 ESMO Congress.
The frontline setting in RCC has undergone a drastic change following frontline indications with cabozantinib (Cabometyx) and the combination of nivolumab (Opdivo) and ipilimumab (Yervoy). Moreover, data from the JAVELIN Renal 101 trial showed the superiority of axitinib (Inlyta) and avelumab (Bavencio) over sunitinib (Sutent) in the frontline setting. Its impact extended to all patients, regardless of PD-L1 status or risk status. If the combination is approved, it will become a practice-changing regimen in the frontline setting, says George.
Moreover, a prospective analysis of the phase III S-TRAC trial demonstrated the importance of disease-free survival (DFS) in adjuvant RCC, says George. The analysis showed that treatment with sunitinib for up to 1-year delayed DFS by about 24% in high-risk patients with RCC. Following all these data, George believes physicians have to redefine the second-line setting with combinations that may include TKIs like cabozantinib and other novel therapies.
In prostate cancer, physicians saw more data from the STAMPEDE trial, which showed a benefit of localized therapy in patients with metastatic hormone-sensitive disease with 3 or less metastases. Patients who received consolidative radiation therapy following the standard of care—–androgen deprivation therapy and docetaxel––experienced a benefit in both progression-free survival and overall survival. This points to the biologic difference between patients with limited metastatic disease and patients with extensive metastases, and further defines the patients who stand to benefit the most from local consolidative therapy versus systemic therapy, states George.