American Society of Oncology (ASCO) Annual Meeting was held from 1 to 5 June 2018, McCormick Place, Chicago, IL, USA. A team of doctors from ONCOCARE CANCER CENTRE (Singapore) attended the meeting and below are important medical oncology updates for patients with kidney cancer, bladder cancer and prostate cancer to consider in discussion with their cancer specialists.
The medical management of kidney cancer has undergone significant progress over the past decade with approval of several targeted agents and immunotherapy drugs. Just in the last 3 years, FDA has approved 4 new drugs and/or combinations in the treatment of advanced clear cell kidney cancer (Nivolumab, Cabozantinib, Lenvatinib, Nivolumab plus Ipilimumab). In Nov 2017, FDA approved treatment of high risk kidney cancer patients after surgery with Sunitinib, to reduce their risk of recurrence based on results from the S-TRAC trial.
The theme for advanced kidney cancer treatment in ASCO 2018 revolved around combination of anti-VEGF directed targeted drugs (Axitinib, Lenvatinib, Cabozantinib, Bevacizumab) and immunotherapy drugs (Nivolumab, Pembrolizumab, Atezolizumab) in first line setting. Preliminary efficacy and toxicity results of multiple combination trials were presented and were impressive compared to previous trials. However, we await the final results of these ongoing studies and approval by regulatory authorities, prior to incorporating these combinations in our routine practice. A large study from
France called the CARMENA trial showed us that removal of the diseased kidney may not always be required in intermediate or poor risk advanced kidney cancer patients who are treated with Sunitinib.
We believe that the future for treatment of advanced kidney cancer looks very promising indeed.
The treatment of advanced bladder cancer has also undergone a remarkable transformation over past 2 years with approval of multiple immunotherapy drugs (Pembrolizumab, Atezolizumab, Durvalumab, Nivolumab and Avelumab). While Atezolizumab and Pembrolizumab can be used in advanced bladder cancer in the first line setting (in appropriately selected patients with PDL1 positive cancers as per FDA label), the rest of the drugs are approved in patients who have already received chemotherapy. Like in kidney cancer, there are multiple ongoing trials looking at immunotherapy and chemotherapy combinations and sequences in advanced bladder cancer. Studies using targeted agents including anti-VEGF and anti-FGFR were also presented and appear promising.
At OncoCare Cancer Centre (Singapore), we offer cancer patients an updated comprehensive and systemic approach to treatment and care, while ensuring evidence-based, safe and cost-effective use of cancer drugs and preserving the quality of life of cancer patients through the entire cancer journey. In this way, one can hope to be comfortable even in the setting of advanced cancer.
PSMA scan images of an advanced prostate cancer case. The arrows demonstrate bone metastases.
“Expert knowledge means better care for cancer”
DR Akhil Chopra
American Board Certified (Int Med)
American Board Certified (Hematology)
American Board Certified (Med Oncology)