August 12, 2023
This discussion marked a significant milestone in the field of genitourinary oncology. Dr. Mar's insightful presentation delved into various scenarios, revealing the complex landscape of oncology care and the advancements in treatment strategies.
At the outset, Dr. Mar disclosed her affiliations with leading pharmaceutical companies, including Seattle Genetics, Aveo, Eisai, Tempus, and Merck, which underscores the relevance of her insights and findings in the context of emerging therapies and clinical trials.
The seminar addressed three distinct scenarios, each portraying intricate clinical challenges and groundbreaking research. In the first scenario, a 70-year-old man presented with recurrent episodes of gross hematuria, prompting a series of diagnostic investigations. Imaging studies unveiled an asymmetric bladder wall thickening and perivesicular fat stranding, prompting further concern. The identification of high-grade urothelial carcinoma invasive into the muscularis propria through transurethral resection of bladder tumor (TURBT) initiated discussions on optimal management strategies.
Dr. Mar skillfully navigated the audience through the decision-making process for nonmetastatic muscle-invasive bladder cancer (MIBC). The eligibility for cystectomy and cisplatin-based therapies were evaluated, with an emphasis on the benefits of neoadjuvant chemotherapy (NAC). The rationale behind NAC, including immediate treatment of micrometastatic disease and the potential to downstage unresectable tumors, was highlighted. Furthermore, the utilization of NAC to identify patients with aggressive disease who could be spared unnecessary cystectomy was discussed, with references to key studies shedding light on these concepts.
The presentation took an even deeper dive into the realm of bladder cancer management, elucidating the outcomes of various NAC regimens through retrospective reviews and prospective studies. Dr. Mar revealed pivotal data from the VESPER trial, demonstrating the long-term impact of neoadjuvant dose-dense MVAC (ddMVAC) versus Cis/Gem regimens on overall survival (OS) and disease-specific survival (DSS). This comprehensive analysis painted a clear picture of the nuances in treatment response and prognosis, considering factors such as the chemotherapy arm, cystectomy rate, and causes of death among patients.
The second scenario portrayed a 56-year-old woman diagnosed with metastatic clear cell renal cell carcinoma (RCC), heralding the introduction of immune checkpoint inhibitors and targeted therapies. Dr. Mar led the audience through the evolving treatment landscape, with a focus on combinations like Pembrolizumab/Axitinib. The significance of key trials, such as CheckMate 214, Javelin Renal 101, and KEYNOTE-426, was underscored, showcasing the efficacy of these treatments in different risk groups and their impact on overall survival, response rates, and progression-free survival.
The seminar then pivoted to the third scenario, where a 68-year-old man with metastatic castration-resistant prostate cancer (mCRPC) experienced disease progression despite initial positive responses to Relugolix and Abiraterone. Dr. Mar explored the intriguing realm of PARP inhibitors, shedding light on the prevalence of DNA damage repair (DDR) alterations and the role of homologous recombination repair (HRR) in prostate cancer. The PROfound and TRITON-2 studies took center stage, highlighting the efficacy of single-agent PARPs such as Olaparib and Rucaparib, as well as the potential of combination therapies.
Dr. Mar's presentation then delved into the details of the PROpel and TALAPRO-2 studies, revealing the promise of PARP inhibitor combinations with Abiraterone and Enzalutamide, respectively. The trials' design, patient populations, and outcomes were meticulously dissected, showcasing the benefits of these regimens for patients with mCRPC and DDR alterations. Additionally, the adverse event profiles and quality of life implications were discussed, underscoring the need for individualized treatment approaches.
The seminar concluded with a reminder of the importance of comprehensive genomic sequencing for patients with locally advanced and metastatic prostate cancer, underscoring the evolving landscape of precision medicine in oncology care.
In summary, the "MOASC SPOTLIGHT ON ONCOLOGY - GU ASCO UPDATES" seminar led by Dr. Nataliya Mar encapsulated the evolving paradigm of genitourinary oncology. Through comprehensive case scenarios, cutting-edge research, and meticulous data analysis, Dr. Mar provided invaluable insights into the current state and future directions of treatment strategies, offering hope and inspiration to both clinicians and patients in the field of oncology.