Matthew D. Galsky, MD, associate professor, medicine, hematology and medical oncology, assistant professor, urology, The Mount Sinai Hospital, discusses a biomarker development trial of satraplatin in patients with metastatic castrate-resistant prostate cancer (mCRPC).

Satraplatin is an oral platinum drug that has been tested in phase III trial but did not show survival benefit and was not approved by the FDA. Galsky says that satraplatin represents a clear example of a drug that has objective evidence that it works and inhibits tumor growth but did not work in enough patients.

The question remains as to whether it’s possible to identify which patients will respond to satraplatin. In this trial, about half of the patients saw benefit with satraplatin, consistent with phase III results, and now tumor samples are being analyzed.

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Matthew D. Galsky, MD, associate professor, medicine, hematology and medical oncology, assistant professor, urology, The Mount Sinai Hospital, discusses a biomarker development trial of satraplatin in patients with mCRPC.

Dr. Galsky on Biomarkers for Satraplatin in mCRPC

Matthew D. Galsky, MD, assistant professor of medicine, Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, director, Genitourinary Medical Oncology, Tisch Cancer Institute at Mount Sinai Medical Center, discusses the role of ipilimumab in bladder cancer.

Galsky says physicians are still trying to determine the role of ipilimumab in bladder cancer. When patients with early stage bladder cancer are given drugs like ipilimumab before surgery, the surgery sample shows that the drug is achieving its goal of recruiting immune cells to the tumor.

Even though biologically and mechanistically the drug is doing what it is supposed to do, Galsky says, it has not yet been translated into the treatment of advanced bladder cancer. In order to take the next step, researchers are exploring ipilimumab in patients with metastatic bladder cancer by first giving chemotherapy in an attempt to kill cancer cells and release tumor antigen. Galsky says the hope is that ipilimumab will then be able to augment the immune system to attack the cancer cells.

Dr. Galsky on the Role of Ipilimumab in Bladder Cancer

Matthew D. Galsky, MD, assistant professor of medicine, Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, director, Genitourinary Medical Oncology, Tisch Cancer Institute at Mount Sinai Medical Center, explains the mechanism of action of ipilimumab in bladder cancer.

Ipilimumab is an antibody that blocks the immune checkpoint CTLA-4, Galsky says. In order for the immune cell to recognize an antigen, an antigen-presenting cell must present the antigen to a T cell. Glasky says this interaction leads to an immune response only when certain co-stimulatory molecules need to be engaged as well. However, if there is an interaction between CTLA-4 and the co-stimulatory molecules, there is an inactivation of T cells. Galsky says this is one of the ways that tumors evade the immune system.

Ipilimumab blocks the CTLA-4 interaction so that the T cells can become activated.

Matthew D. Galsky, MD, from the Tisch Cancer Institute at Mount Sinai Medical Center, explains the mechanism of action of ipilimumab in bladder cancer.

Dr. Galsky on Ipilimumab in Bladder Cancer

Matthew D. Galsky, MD, director, Genitourinary Medical Oncology, associate medical director, Cancer Clinical Trials Office, Mount Sinai Medical Center, The Tisch Cancer Institute, discusses the development of a post-treatment prognostic model following treatment with first-line chemotherapy for patients with metastatic urothelial cancer.

Data was pooled from 317 patients who were enrolled in 8 clinical trials that were evaluating first-line cisplatin in metastatic urothelial cancer. To create the post-treatment nomogram, established pretreatment variables were combined with response to treatment, the duration of chemotherapy, and the reason for stopping treatment.

The duration of treatment and treatment discontinuation were not found to correlate with changes in survival, Galsky notes. Overall, the only post-treatment factor that was associated with survival was response to chemotherapy. Following an independent validation, the nomogram contained 4 indicators: response to chemotherapy, number of visceral metastatic sites, ECOG performance status, and whole blood cell counts.

Galsky believes these findings are particularly important for patients who want to know what comes next after treatment. Additionally, it may help select patients who are eligible to participate in maintenance therapy trials.

Matthew D. Galsky, MD, from the Mount Sinai Medical Center Tisch Cancer Institute, discusses the development of a post-treatment prognostic model for patients with metastatic urothelial cancer.

Matthew D. Galsky, MD

Articles

Dr. Galsky on Biomarkers for Satraplatin in mCRPC

Dr. Galsky on the Role of Ipilimumab in Bladder Cancer

Dr. Galsky on Ipilimumab in Bladder Cancer

Dr. Galsky on a Post-Treatment Nomogram in Urothelial Cancer