Welcome to The GU Cancer Sessions with the Video Journal of Oncology (VJOncology).
This roundtable discussion features Arlene Siefker-Radtke (University of Texas MD Anderson Cancer Center, Houston, TX), Alison Birtle (Lancashire Teaching Hospitals, Preston, UK), Andrea Apolo (National Cancer Institute, Bethesda, MD) & Thomas Powles (Barts Cancer Institute, London, UK).
The panel offer their perspectives on the key bladder and kidney cancer data presented at the 2021 American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium including EV-301, CheckMate 274, POUT, CaboNivoIpi and more. They experts also debate how the latest advancements could change practice and what it all means for genitourinary cancer patients in the future.
Enfortumab vedotin in urothelial carcinoma
“Just as with chemotherapy and immune therapy, when they came along, we learned how to use those drugs. We’re going to need to learn to use enfortumab vedotin from a global perspective as well. And I’m really keen to take part in that educational process. I think it’s practice changing. My current standard of care will be frontline chemotherapy, maintenance evalumab, and EV at first progression. So that would be how I would treat patients. I know there are other people who feel differently about that.”
– Thomas Powles
Adjuvant nivolumab & CheckMate 274
“So that’s a really great point about the use of disease free survival compared to overall survival. And I believe the trial that you’re referring to from Cora Sternberg was her adjuvant trial, where patients received either adjuvant chemotherapy or chemotherapy at progression. And with the use of an adjuvant strategy, it really enhances that disease free survival endpoint. But if people do not have a cure from therapy, and it’s only delaying the inevitable then we may not see that long term survival, which could account for some of the lack of survival, when patients receive the same treatment at progression of disease. So looking at survival endpoints become very important.”
– Arlene Siefker-Radtke
Upper tract UC & POUT
“This year we presented the mature data, which shows that…at three years and at five years, there’s an improvement in both disease free and metastasis free survival in favor of adjuvant chemotherapy… And the overall survival data was 12%, but was not statistically significant. And I think there’s a number of reasons behind that. One, it’s a secondary endpoint. Two, the study shut prematurely because we’ve met the primary endpoints. And at that point, there were 261 patients randomized, compared with the 346 we’d intended to recruit for which study was powered for overall survival.”
– Alison Birtle
TKI + immunotherapy combinations & RCC
“I presented the final results of the Phase I trial that included the dose escalation portion and seven expansion cohorts in GU all tumors, including bladder and kidney cancer and rare tumors with a doublet of cabozantinib-nivolumab, and the triplet of cabozantinib, nivolumab and ipilimumab.
And in this very heterogeneous group of patients, we saw a really nice response. We saw 38% response in these patients with 11% complete response and the duration of response was 23 months. So that’s really excellent. In bladder cancer patients, the overall response rate was 42%, with 21% of patients having a complete response and in kidney cancer, the response was remarkable, 63% of overall response rate, including sarcomatoid. And this data, really informed the safety and preliminary efficacy for larger trials that are ongoing.”
– Andrea Apolo
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