COMMENTARY

What to Watch for in Genitourinary Cancers

David Graham, MD

Disclosures

May 27, 2016

In This Article

The abstract release day for the American Society of Clinical Oncology (ASCO) Annual Meeting always carries a degree of excitement. Certainly, the finance sector reviews the abstracts with great interest, but I see it as a chance to help plan what I am most interested in hearing more about. The ASCO Annual Meeting can be pretty imposing without a little pre-planning. When browsing the abstracts, it helps to remember that the ones starting with "TPS" are simply descriptions of trials with no real data presented, while the abstracts starting with "e" are electronically published only. The review process has stratified them to the lowest level. I have reviewed the presentations related to genitourinary cancers, and the following studies piqued my interest.

Bladder Cancer

The US Food and Drug Administration's (FDA's) recent approval of atezolizumab for bladder cancer was a timely herald for the amount of data that will be presented regarding the drug's activity in that disease. A number of abstracts describe data from the IMvigor 210 trial of atezolizumab use in first-line metastatic disease; because of the prevalence of these data, I'd like to point out some of the other studies being presented.

We have understood that obtaining a complete response from neoadjuvant chemotherapy in breast cancer can be a good prognostic indicator. Abstract 4537 describes the experience at Columbia University of 44 patients who achieved a complete response following neoadjuvant chemotherapy for bladder cancer, with the question being whether they could avoid radical cystectomy. In this cohort, 14 patients were able to preserve their bladder with no recurrence of disease. Another 11 had recurrence as carcinoma in situ. The overall survival after a median follow-up of more than 3 years was 72%.

In indolent lymphomas and non–small cell lung cancer, the use of maintenance therapy has a proven role. Abstract 4529 reports results of a trial looking at the use of vinflunine as maintenance therapy following gemcitabine/cisplatin given for four to six cycles that achieved either a response or stable disease. In this European multicenter trial, a statistically significant increase in progression-free survival of 1.9 months was reported. Survival results are not yet available. Granted, this is a relatively small trial of 88 patients and it is looking at a drug not available in the United States, but it certainly raises an interesting question. Two trials looking at sunitinib as maintenance therapy have been completed in the United States, and a trial looking at pembrolizumab is now accruing.

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