2017 Genitourinary Cancers Symposium Day 2 Update

gu_symposium_2017_img_3054Following an initial “Best of Journals” session on prostate cancer, Day 2 of the ASCO Genitourinary (GU) Cancers Symposium focused on bladder, ureteral, penile and germ cell cancers.

The Best of Journals prostate cancer session featured Weill Cornell Medicine (WCM) and NewYork-Presbyterian (NYP) Hospital’s Dr. Jim Hu as the expert surgeon, as well as collaborators Joshua Lang from the University of Wisconsin – Madison and Robert Den from Thomas Jefferson University as the medical oncology and radiation oncology experts.

The main morning session was focused on “optimizing outcomes in muscle-invasive and metastatic bladder cancer.” The session included patient case presentations and a discussion regarding the best available evidence for managing bladder cancer with a multidisciplinary team of medical oncologists, urologists and radiation oncologists.

Former WCM trainee and attending physician Dr. Matthew Milowsky (currently at the University of North Carolina) gave an excellent year-in-review lecture highlighting recent advances in immunotherapy for urothelial cancer including the FDA approval of two immune-checkpoint inhibitors in patients previously treated with chemotherapy (with more expected this year) and the recent frontline studies in cisplatin-ineligible patients. Dr. David McConkey from Johns Hopkins delivered the Keynote Lecture on urothelial carcinoma, highlighting the emerging impact of genomics on the clinical management of bladder cancer.

The 2nd morning session reviewed the best treatment choices for localized bladder cancer and discussed both systemic (infused into veins) and intravesical (bladder instillation) delivery of medications to improve outcomes. Prior to removing the bladder (referred to medically as radical cystectomy), neoadjuvant (before surgery) chemotherapy remains the standard. For patients with higher grade (more aggressive) or recurrent bladder cancer following resection of tumor via cystoscopy, instillation of the traditional immune agent BCG into the bladder is the standard, but does not cure all patients. Dr. James McKiernan a urologist at NewYork-Presbyterian Columbia discussed treatment options for these patients.

The abstract session included several high-quality abstracts focusing on genomic analysis of upper tract and variant urothelial carcinomas. Dr. Bishoy Faltas presented a poster titled “Punctuated evolution of copy-number alterations defines two molecular subtypes of muscle-invasive urothelial carcinoma” that showed the bladder cancer can be divided into two clusters based on alterations in the number of copies of a set of genes in each patient’s tumor sample. Dr. Scott Tagawa presented a poster describing updated results after treating a much larger cohort of patients with refractory metastatic urothelial cancer with the antibody-drug conjugate IMMU132 (sacituzumab govitecan). The patients in this clinical trial represent a traditionally difficult-to-treat patient population, as they have extensive metastatic disease and have already undergone an average of two prior therapies. Hear firsthand from Dr. Tagawa as he explains these updated trial results with OncLive:

In the oral abstract session, chemotherapy in addition to radiation was confirmed to be better than radiation alone for bladder cancer. Additional information on molecular subtypes of urothelial carcinoma and associations with pre-operative chemotherapy were also discussed.

For testicular cancer, additional information on results of one cycle of the most common chemotherapy combination, BEP, following surgical removal of the testis tumor was associated with a high cure rate. The French presented their cooperative group experience with high dose chemotherapy including drug monitoring prior to stem cell transplant for patients with relapsed germ cell tumors.

A multidisciplinary session on the treatment of penile and urethral cancers discussed genomics, radiation, surgery, and systemic therapy. Experience with the targeted drug dacomitinib was presented in the earlier oral abstract session demonstrating responses in a subset of patients with metastatic urothelial carcinoma.

The day ended with the Year in Review on penile cancer presented by Dr. Asif Muneer and the Keynote Lecture on testicular cancer was delivered by Dr. Lawrence Einhorn from the Indiana University School of Medicine. Dr. Einhorn is one of the luminaries in the field and introduced platinum combination therapy for testicular cancer in 1974. This transformed the treatment of the disease, which previously was fatal for approximately 90% of patients. Dr. Einhorn highlighted that today, with the addition of chemotherapy treatment, approximately 95% of all patients diagnosed with testicular cancer will be cured.

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