Sumanta Kumar Pal, MD
The field of genitourinary (GU) malignancies is seeing an influx of potential therapeutic options with a new drug application submitted for apalutamide (ARN-509) in prostate cancer, immunotherapy approvals in bladder cancer, and the promising results with frontline cabozantinib (Cabometyx) in kidney cancer.
In prostate cancer, Janssen Biotech recently announced the submission of a new drug application to the FDA for the next-generation oral androgen receptor inhibitor apalutamide for the treatment of patients with nonmetastatic castration-resistant disease.
In renal cell carcinoma (RCC), the primary analysis (investigator assessment) of the phase II CABOSUN trial showed a median progression-free survival of 8.2 months with the frontline use of cabozantinib compared with 5.6 months with standard sunitinib (Sutent) (HR, 0.66; 95% CI, 46%-95%; 1-sided P
= .012). Based on these data, the FDA has granted a priority review to a supplemental new drug application for the frontline use of cabozantinib in RCC.
Sumanta K. Pal, MD, recently chaired the OncLive®
State of the Science SummitTM
in Genitourinary Cancers and moderated a panel on kidney and bladder cancer options. In an interview during the meeting, Pal, a medical oncologist and assistant clinical professor in the Department of Medical Oncology and Therapeutics Research at City of Hope, discussed these advances and potential new therapies across GU malignancies.
OncLive: Could you touch on some of the recent advances in GU cancers?
Across the board, there have been huge developments in each field. In bladder cancer, there have been a lot of developments in using immunotherapy, and our discussion today hinged on how these drugs are sequenced and how practitioners can choose between them. In kidney cancer, the big shockwaves came from CheckMate-214, a trial of nivolumab (Opdivo) and ipilimumab (Yervoy) in the frontline setting. Dr Neeraj Agarwal and others discussed how we could potentially incorporate that into our current therapy. Finally, we have a lot of discussion centered around prostate cancer, specifically the use of chemotherapy, and how to sequence radiation and local therapies—there were a lot of great topics across the board.
We saw exciting data at the 2017 ESMO Congress with cabozantinib. What kind of impact would this have if it is approved in the frontline setting for RCC?
There were a lot of new data from ESMO; I would definitely say that cabozantinib has proven itself as our best VEGF tyrosine kinase inhibitor (TKI) through CABOSUN. We see improvements in progression-free survival, response rate, and overall survival, and this has really stood up to the test of independent review. A lot of the data we saw there were confirmatory.