Mixed Study Results in GU Tumor Types Reported From 2015 ECC

OncLive Chairman,

Mike Hennessy

The bulk of this month’s articles come from the 2015 European Cancer Congress in Vienna, Austria. We lead off with positive news in bladder cancer regarding atezolizumab as second-line therapy in patients with metastatic urothelial carcinoma (mUC) who had a poor prognosis after progressing following platinum-based chemotherapy. Results from IMvigor 210 demonstrated significant overall response rate (ORR) improvements across all groups with higher PD-L1 expression. ORR by RECIST 1.1 was 15% (P = .0058) in all comers, 18% (P = .0004) at the IC1/2/3 level (any PD-L1 expression), and 27% (P = .0001) in the IC2/3 subgroup with PD-L1 expression ≥5%.

This is welcome news because currently available treatments in metastatic urothelial cancer are “dismal,” according to the lead investigator, Jonathan Rosenberg, MD, a medical oncologist at Memorial Sloan Kettering Cancer Center. The agent has the potential to change the standard of care in metastatic urothelial carcinoma.

In renal cancer news, we report on the phase III METEOR study, which compared second-line treatment of cabozantinib (Cometriq) with everolimus in patients with advanced kidney cancer who have received prior standard therapy that targets the vascular endothelial growth factor receptor. Investigators noted a significant reduction in the rate of disease progression or death in the cabozantinib arm as compared with the everolimus arm.

It was not all positive news in RCC, however. The IMA901 multipeptide vaccine failed to improve outcomes when added to sunitinib as first-line therapy for advanced/metastatic in RCC. The open-label phase III trial compared the multipeptide vaccine in combination with sunitinib with sunitinib alone, which is standard first-line therapy and is thought to have immune-boosting properties. “There was no overall survival advantage to the investigational arm of the vaccine. In fact, the hazard ratio favored the control arm of the trial,” said lead author Brian Rini, MD, associate professor of medicine, the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University.

In prostate cancer, results from the tasquinimod trial were not encouraging. Though initially promising in phase II trials, the agent failed to improve overall survival in a phase III trial in men with treatment-naïve metastatic castration-resistant prostate cancer. The manufacturers, Active Biotech and Ipsen, have discontinued development. Finally, an updated analysis of the STAMPEDE trial upholds the survival benefit observed with early use of docetaxel in advanced prostate cancer, but does not support the introduction of zoledronic acid.

Other feature articles included in this month’s issue focus on the benefits of a multidisciplinary care approach when radium-223 is added to the treatment regimen in advanced prostate cancer. The Genitourinary Multidisciplinary Clinic, a program of The Comprehensive Cancer Center at The Miriam and Rhode Island hospitals and which opened in 2007, incorporates 4 medical disciplines: medical oncology, radiation oncology, urologic oncology, and nuclear medicine physicians, with support from other services to enhance the patient experience and operational efficiency. Joseph F. Renzulli II, MD, and colleagues described an efficient and cost-effective workflow through their clinic that relies on the collaboration between many specialists.

This month’s Practice Profile column highlights the work of the Urologic Cancer Center (UCC) provided by Urology Centers of Alabama. Before the UCC opened, president Mark DeGuenther, MD, said that they found the urologists were categorized into 3 camps: those who had a keen interest in treating patients with advanced prostate cancer with emerging therapies, those who had a passing interest, and those who had no interest. The column describes how patient care was optimally provided.