ESMO 2017: Day 2 Recap

IMG_3948The second day of ESMO included the oral genitourinary (GU) oncology session that focused on renal cell (kidney) and urothelial (bladder) carcinoma.

Several years ago, the SWITCH study evaluated the sequence of sunitinib and sorafenib showing similar overall progression free survival and overall survival regardless of the order by which each drug was utilized. At ESMO 2017, results of the SWITCH-II trial were presented. This study tested the sequence of pazopanib and sorafenib in patients with advanced RCC of any histology (i.e. clear cell or non-clear cell).  The study sought to enroll 544 patients, but stopped after 377 patients due to slow accrual. Only half of the patients remained on study and switched to their assigned drug after tumor growth on drug #1. Overall, while the study didn’t complete planned accrual, there was a trend for improved progression-free and overall survival for the pazopanib → sorafenib sequence.

Historically when most patients were treated with cytokines (IL-2 and interferon), two randomized trials by U.S. and European cooperative groups showed that in the setting of metastatic kidney disease, patients live longer by first removing the kidney mass and then treating with interferon rather than treating with interferon without removal of the kidney. Since the introduction of new therapies in late 2005 which have higher rates of tumor shrinkage and longer lifespans for patients, it is unknown if patients should still have their kidney tumor removed prior to drug therapy.

IMG_3954In the EORTC 30073 SURTIME trial, European investigators decided to try to assess whether tumors remained under control longer and patients lived longer if surgery was performed first or if patients initiated sunitinib for 3 cycles prior to cytoreductive nephrectomy. Because enrollment was slow, the study design was changed to assess the percent of patients that were free of tumor progression at 28 weeks. Ninety-nine patients were randomized to immediate versus delayed surgery, most with large kidney tumors and intermediate-risk cancer. Overall there was no difference in the percent with cancer progression at 28 weeks with either approach.  With the caveat of a small study, there were trends for longer survival and less surgical complications in those with delayed surgery. While the amended study is not able to prove that delayed surgery is the better approach, it gives comfort for those physicians/patients that the choice to initiate medical therapy and then re-evaluate for surgery is acceptable. We await the results of the larger CARMENA study that is testing surgery followed by drug versus drug alone (with no surgery) to see if removal of the primary kidney tumor is necessary.

Additionally, two early-phase studies of novel drug combinations of immunotherapy + targeted therapy were presented. In a phase I study led by the NCI, the safety of the combinations of cabozantinib/nivolumab and cabozantinib/nivolumab/ipilimumab were tested in patients with a number of different treatment-refractory tumor types, especially urothelial and other types of bladder cancers. Overall, both combinations were deemed to be safe and are moving forward in a phase III trial. However, many toxicities did occur and most patients needed to reduce the dose of at least one drug so these combinations should only be used in a clinical trial setting.

IMG_3958The phase II portion of a phase I/II study testing the combination of lenvatinib + pembrolizumab. The initial (phase 1) portion of the study presented at ESMO 2016 determined the safe dose in patients with different types of tumors (mostly RCC). This year, new results were presented with 22 additional patients added to the 8 previously treated on the phase I portion. Overall, there was an impressive tumor response rate of 63%, with 83% significant tumor shrinkage in those patients treated in the 1st line setting. This combination is also being tested in a phase III study for patients with advanced RCC which will soon be opening at Weill Cornell Medicine and NewYork-Presbyterian.

Missed our Day 1 Recap of ESMO 2017? Check it out here.

Get Ready for ESMO 2017

The start of fall is here and with the foliage comes a very busy conference season. Up first, we are headed across the ocean to Madrid, Spain for the European Society for Medical Oncology (ESMO) annual meeting from September 8 – September 12.

ESMO LOGO

Our team will be joining nearly 23,000 cancer researchers from 131 countries for this important meeting highlighting the groundbreaking research in cancer. Some of our physicians and scientists from Weill Cornell Medicine and NewYork-Presbyterian will be attending and presenting their research in prostate, bladder, and kidney cancer.

We have a lot to share at ESMO 2017, so please follow along on our social media channels and blog for more updates throughout the weekend and next week.

Genitourinary Oncology Physicians Awarded Prestigious 2017 Castle Connolly Top Doctors Designation

The Weill Cornell Medicine and NewYork-Presbyterian Genitourinary Oncology Program is proud to announce that our physicians have been identified as Castle Connolly 2017 Top Doctors for cancer in the United States and in the New York Metro area. This further validates our long-standing commitment to patient care and the advancement of medicine. 

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WCM/NYP Genitourinary (GU) Medical Oncologists

Each year, Castle Connolly, an established healthcare research company located in New York, bases its selection through a peer-review process, extensive research and screening of nearly 100,000 nominations. This nomination shows that not only do our physicians have a great reputation, but they are also recognized by other doctors who can attest to their commitment to the field of genitourinary oncology.

“Within the Genitourinary Oncology Program, we are dedicated to providing cutting-edge care and access to clinical trials for people with all stages and types of prostate, kidney, bladder and testicular cancer,” said Scott Tagawa, MD, Medical Director of the Genitourinary Oncology Research Program at Weill Cornell Medicine.

Diagnosing and using the latest technologies to molecularly characterize and find the right treatment for each patient is an individualized process. Physicians in the Genitourinary Oncology Program, as well as other cancer experts throughout Weill Cornell Medicine and NewYork-Presbyterian, utilize an approach to treatment known as precision medicine that assesses individual variability in the tumor’s genes and microenvironment. This allows our physicians and researchers to better understand and predict which treatment approach will work best for each patient, without using a “one-size-fits-all” approach.   

According to Dr. Tagawa, “Patient care is our utmost priority and winning this prestigious Castle Connolly Top Doctors award is a testament to our dedication to improving the lives of our patients. I’m honored to be part of such a comprehensive and multidisciplinary team.”

Congratulations to the GU physicians on this outstanding achievement!

About Castle Connolly and America’s Top Doctors
CC 2017
The mission of
Castle Connolly Medical Ltd. is to help consumers find the best h
ealthcare. They publish a variety of books including the “Top Doctors” series, the most popular of which is America’s Top Doctors®. Doctors who are among the very best in their specialties and in their communities are selected for inclusion.