Promising but mixed prospects for systemic therapy in urological cancers

There are emerging and promising treatment options for urological cancers, but major advances in prostate, kidney and bladder cancers are still beyond reach due to the lack of solid data, serious side-effects and some drawbacks in combination drug trials.

With the aim to present an overview of how clinical factor and genomic medicine might impact the current standard of care, the session, chaired by Prof. Maria de Santis (AT), presented four state-of-the-art lectures on the integration of clinical and genomic data, the role of chemotherapy in prostate cancer, systemic therapy for renal cell cancer and second-line chemotherapy for urothelial cancer.

Prof. Anders Bjartell (SE) spoke on the integration of biomarkers and genomic data with clinical features and what can be expected in the coming years.

“The challenges in genomics is that there is an enormous amount of data to interpret, and there is a need how to identify truly functional ‘driver’ mutations…” said Bjartell. He added that researchers need tumour material in order to better understand tumour heterogeneity. “Morever, we need to collaborate and to validate news discoveries. We also need prospective studies,” he noted.Prof. Peter Albers, meanwhile, addressed the issue of chemotherapy’s role in prostate cancer and spoke on the efficacy of docetaxel as a standard first-line treatment for metastatic castration resistant prostate cancer (mCRPC).

In his summary conclusions, he said that abiraterone is an alternative in the first-line setting, and that patient selection for chemotherapy hinges on good performance, the Gleason score (8-10), visceral metastases and age (<65 yrs). He added that cabizitaxel is standard second-line chemotherapy in CRPC with abiraterone as alternative.

Asst. Prof. Axel Merseburger (DE) lectured on systemic treatment for renal cell carcinoma, presenting a treatment landscape that is dominated by molecularly targeted and anti-angiogenic agents which are now the basis of many kidney cancer treatment regimens.He described an overview of the clinical efficacies of systemic agents such as immune-based therapies (PD-1 inhibitors, vaccines), novel targets and novel tyrosine kinase inhibitors (TKIs).

“Pazopanib is not inferior to sunitinib with better health-related quality of life (COMPARZ trial),” he said, and added that second-generations TKIs seem to be associated with fewer side effects. “There is no benefit for combination, but more toxicity,” he added, whilst noting that smart sequence therapy (SST) is the gold standard in metastatic kidney cancer.De Santis spoke on second-line chemotherapy for bladder cancer, underscoring the fact that while there are improvements in surgical or radical treatment techniques, the same cannot be said for systemic therapy, which in recent years has seen little progress since the 1970s with BCG, or the use of M-VAC in the 1980s.

In her lecture she spoke on vinflunine-based studies, particularly phase 3 trials which looked into vinflunine combined with best supportive care (BSC), and randomized against BSC alone in patients failing first-line platinum-based combination chemotherapy. She said the results showed a survival benefit in favour of vinflunine, which showed significance in the eligible patient population.“Vinflunine is the only EMA-approved agent in the second-line setting,” said De Santis, as she underscored that future prospects include antiangiogenic treatment and the need for resources in genomic profiling studies, prospective validation and clinical studies.