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Updates in kidney cancer, bladder cancer and prostate cancer treatment, ASCO 2018
Updates in kidney cancer, bladder cancer and prostate cancer treatment, ASCO 2018

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.

Kidney Cancer

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.

Bladder Cancer

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.

 

Prostate Cancer

In line with the theme of precision oncology at this year’s ASCO 2018, there were many abstracts presented on the genomic characterization of prostate cancer and identification of potentially actionable mutations (  both germline and somatic). However, it is quite evident that genomics of metastatic prostate cancer is complicated and heterogeneous and more work needs to be done in this area. DNA repair defects are more common than previously thought and respond to treatment with platinum agents and PARP inhibitors. A study from the UK (abstract 5003) showed benefit of olaparib (PARP inhibitor) and Abiraterone Acetate in advanced castration resistant prostate cancer (mCRPC) in an unselected group of patients. This was a small study and we need to wait for more data before adopting this approach in clinical practice. There were a number of studies looking at the role of immunotherapy drugs in mCRPC as well. Keynote 199 trial evaluated the benefit of Pembrolizumab (Keytruda) in chemotherapy resistant mCRPC cancer and demonstrated some efficacy with acceptable safety. With the availability of multiple effective new hormonal agents (Enzalutamide, Apalutamide and Abiraterone Acetate), we need to further define the best way to sequence these agents in the treatment of advanced prostate cancer. Chemotherapy (Docetaxel, Cabazitaxel) continues to play an important role.

  

    PSMA scan images of an advanced prostate cancer case. The arrows demonstrate bone metastases.

 

 

“Expert knowledge means better care for cancer”

DR Akhil Chopra
MBBS (Delhi)
American Board Certified (Int Med)
American Board Certified (Hematology)
American Board Certified (Med Oncology)