A Meeting of the Minds in Prague

prague-aua-programLast week, approximately 100 of the leading experts in genitourinary (GU) cancer research and treatment converged in Prague in the Czech Republic for the 114th Annual American Urology Association (AUA) Meeting. The AUA’s mission is “to promote the highest standards of urological clinical care through education, research and in the formulation of health care policy.”

The AUA has over 22,000 members from across the country, and many of the Weill Cornell Medicine/NewYork-Presbyterian GU physicians serve as members of the New York chapter. At this year’s meeting, doctors David Nanus, Jim Hu, and Scott Tagawa were invited to present on the latest standards in screening and treatment for prostate, bladder and kidney cancers.

jim-hu_aua-prague-2016On Thursday, September 15th, Dr. Jim Hu spoke about the screening controversy surrounding the early detection of prostate cancer and how this influences present day practice and the medical care men are receiving. We have a number of different screening tools available to detect prostate cancer and distinguish between aggressive and non-aggressive sub-types. One of the most common and least invasive ways to screen for prostate cancer is through Prostate Specific Antigen (PSA) testing, but this is controversial because some argue that it leads to false positives, or the detection of cancers that are very slow growing and may never need treatment. Most physicians and scientists agree that PSA testing isn’t perfect, but research shows that it can be a very good screening indicator when used in conjunction with physical exams, biomarkers and imaging tools. In addition, analysis of a recent study demonstrated that surveillance remains an option for some men with little difference in 10-year survival in those that choose treatment with either surgery or radiation, though there are tradeoffs in terms of a higher likelihood of developing advanced cancer in those that avoid more aggressive treatment.

Later that day, Dr. Scott Tagawa provided an update on the impact of chemotherapy in treating prostate cancer – a modality that was once thought to be a treatment last-resort. Chemo is now a standard much earlier on during cancer care and people are living longer, and feeling better as a result. In particular, the earlier use of a short course of chemotherapy at the time that men initially present to the clinic with advance prostate cancer leads to a significant increase in survival combined with better overall quality of life in the longer-term. The two taxane chemotherapy drugs proven to be successful in prostate cancer are docetaxel and cabazitaxel, and the latest research on these drugs seeks to answer questions regarding for whom and when these treatments will be benefit. At Weill Cornell/NYP we are leading the field in this research and developing hi-tech biomarkers to determine sensitivity and resistance.

Dr. David Nanus presented on Friday and highlighted the latest advances in treating urothelial cancers of the kidney and bladder. After nearly three decades with no new FDA drug approvals for bladder cancer, in 2016 we witnessed great treatment advances for bladder cancer. With immunotherapy, chemotherapy and genomics, we’re now on the cusp of precision medicine. The combination of these approaches with novel treatments is improving the lives of many of our patients with advanced urothelial carcinoma. We are now able to offer complete tumor and germline (inherited) genomic analysis as part of research studies that in the near term will translate to selecting the optimal treatment strategy for each individual patient.

Meet the Newest Member of Our Team: Dr. Bishoy Faltas

Bishoy_Faltas_HeadshotWe’re pleased to announce that the Genitourinary (GU) Oncology Program is expanding! Dr. Bishoy Faltas joined us on July 1st as an Instructor in Medicine and as an Assistant Attending Physician. He will see patients with bladder, prostate, testicular, and kidney cancers.

Dr. Faltas may already be a familiar face and name because he completed his Hematology and Medical Oncology Fellowship here at Weill Cornell Medicine and NewYork-Presbyterian Hospital in 2015. Additionally, he recently finished a one-year research fellowship in the laboratory of Dr. Mark A. Rubin and the Institute for Precision Medicine.

As part of the Genitourinary Oncology Program, Dr. Faltas will focus his research on urothelial carcinoma, the most common type of bladder cancer, and specifically on genetic mutations and drug-resistance. He has presented groundbreaking work on genomic alterations before and after chemotherapy and the potential clinical implications. He will also be building upon his prior research examining how patients with bladder cancer respond to immunotherapies.

He has already received numerous research awards for his work, is a member of the Bladder Cancer Advocacy Network, and we are very excited to officially welcome Dr. Faltas to the GU team!

What’s Next for Cutting-Edge Bladder Cancer Treatment?

AN UPDATE ON ATEZOLIZUMAB, AN IMMUNOTHERAPY

Dr. David Nanus, Chief of Hematology and Medical Oncology at Weill Cornell Medicine and NewYork-Prebysterian Hospital and genitourinary (GU) cancer expert, sat down with OncLive TV to discuss future research efforts and next steps for a new immunotherapy drug for patients with bladder cancer. This drug, atezolizumab (brand name Tecentriq), is the first new drug that has been FDA-approved for urothelial carcinoma – the most common type of bladder cancer – in over two decades.

Atezolizumab works by detecting a specific protein (PD-L1) on the surface of tumor cells, allowing the body’s immune system to recognize the cancer and attack it. Ongoing research on this treatment has revealed some complexities that have left physicians and researchers with questions ripe for scientific exploration, especially since this is a newer drug lacking long-term clinical data.

Two important questions remain regarding atezolizumab:

1. Are there biomarkers we can use for this drug?
2. For how long should this drug be administered?

The first question involves “biomarkers” or “biological markers,” indicators in the body that can be measured or tracked. In cancer treatment, oncologists use different biomarkers to glean information about a patient’s diagnosis and prognosis, as well as to monitor treatment effectiveness. Biomarkers can also offer information about safety of a treatment and signal which patients will benefit most from a certain drug. Currently, we do not yet have any biomarkers to predict whether atezolizumab will work. In a recent interview with OncLive TV, Dr. Nanus explains this uncertainty by saying, “There is not going to be one simple biomarker that is going to say to treat or not treat, so that is the unanswered question.”

The second question pertains to duration of treatment. Researchers and physicians are still working to find out when atezolizumab can be safely stopped without losing its benefit, and if the drug can be re-administered in the case of cancer recurrence or relapse. The “right” length of treatment is also linked with cost-effectiveness and accessibility for all patients in need since this drug is very expensive.

These questions are global issues that pertain to many new and emerging cancer treatments, especially immunotherapies that leverage the body’s own immune system to fight the tumors. Immunotherapies are drastically changing the way many cancers are treated, but we still have much more to learn. It is only with time and additional research that we will find the answers to both of these questions.

Hear from Dr. Nanus firsthand:

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