Experts optimistic of advances in treating GU cancers

02 July 2014

Cancer experts are hopeful that current research on genito-urinary malignancies will eventually yield, in the coming years, some breakthrough progress or advances in diagnosing and treating prostate, kidney and bladder cancer patients.

“In prostate cancer, advances would include the evaluation of new genomic biomarkers for smarter detection and or smarter risk prediction. As far as therapy is concerned, primarily in the context of advanced stage disease, there would be advances in both hormone sensitive and castration resistant disease,” said Prof. Maha Hussain, professor of Medicine and Urology and Associate Director for Clinical Research at the University of Michigan Comprehensive Cancer Center.

Hussain will give a lecture titled “Intermittent hormonal therapy – for the worse or the better?” at the upcoming 6th European Multidisciplinary Meeting on Urological Cancers (EMUC) which will be held in Lisbon, Portugal from November 13 to 16. Organised by the ESMO, ESTRO and the EAU and the support of affiliates such as the ESUP, ESUR, EORTC GUCG and EUOG, the 6th EMUC will once again gather the world’s leading cancer experts for a review of developments and prospects in uro-oncology.

In her lecture, she will present her assessment of current data regarding the role of hormone therapy schedule in treating relapsed prostate cancer. “In totality, in the context of hormone sensitive metastatic and non-metastatic PSA-relapsed prostate cancer, current data does not provide compelling evidence to support intermittent therapy as ‘the’ standard of care. Like any treatment decision, risk and benefits must be addressed and decision individualised to what is most appropriate to the specific patient,” she noted.

Doctors are nowadays stressing the crucial role of individual disease characteristics that ultimately will affect whether a certain treatment will succeed. Hussain also added that in the multidisciplinary setting, doctors should apply the practical benefits of recent validated research findings.

“We all need to do a better job in applying Level 1 evidence and a better job in addressing some key questions in a timely manner. For example, despite Level 1 evidence regarding the role of neoadjuvant chemotherapy in bladder cancer, the approach is not widely offered,” said Hussain.

On prostate cancer she noted that there are still several questions that need to be prospectively tested. “For instance, what is the optimal strategy for active surveillance in prostate cancer, what genomic profile is the best to predict clinically significant prostate cancer, and which of the new approved agents in mCRPC is the most optimal first-line treatment and how best to combine and/or sequence the different available treatments in this disease setting,” she pointed out. “Research on cost-effectiveness in GU cancers is also needed considering the escalating costs of new technologies and therapies.”

 Drugs in the pipeline

Dr.  Bernard Escudier, of the Department of Medical Oncology at the Institut Gustave Roussy Hautes Bruyere in Villejuif, France, also gave a positive assessment regarding new treatments for renal cell carcinoma.

“New drugs targeting new targets such as PD1 or cMET are very promising drugs, and are currently in phase 3 trials,” said Escudier who will speak at the EMUC regarding new drugs in the pipeline for kidney cancers.

“I do expect, aside from new targets, also new genetic findings to better assess the prognostics of RCC,” added Escudier. Access to these recent drugs, however, remains an issue for many patients either due to high costs or pending approval in certain countries. “Getting rapid access to new drugs is currently the main obstacle (for these studies) to move rapidly,” he said.

Both Hussain and Escudier are also of the opinion that in the genito-urinary field, bladder cancer certainly needs more research funding.

“I think all advanced GU cancer settings need investments to reduce death and suffering for our patients. However, of all cancers urothelial cancer has been an almost ‘forgotten disease,’ for decades, when it comes to funding,” said Hussain.

“Bladder cancer is a very important GU malignancy,” Escudier conceded. “With rapidly growing evidence that biology is going to change this disease, there are very few advances that have been made in the past 10 years.”

Aside from the 21 sessions that will cover various GU malignancies, the 6th EMUC, which is being held annually since 2011, will open this year on November with the EAU-ICUD Consensus Meeting on Medical Treatment of Urological Malignancies, and the 3rd Meeting of the EAU Section of Urological Imaging (ESUI). Both satellite events are linked to the multidisciplinary themes and issues that underpin the annual EMUC.

For further information on the EMUC, visit http://www.emuc2014.org/home/