AUA 2017: Best Urothelial Cancer papers from 2016
1) Immunotherapy in metastatic disease. Four agents including Atezolizumab, Durvalumab, Pembrolizumab, and Nivolumab have all been or soon will be approved for use in the cisplatin-ineligible or second-line metastatic setting. Dr. Schuckman focused on Rosenberg et al, Lancet 2016 and pointed out that while ORRs were about 15-20%, responses in a minority were durable past 14 months and enriched in patients with high (>5%) percentages of PDL-1 tumor infiltrating leukocytes as assayed by a companion IHC diagnostic test.
2) New nomenclature. In the new WHO classification there is added emphasis on variant histologies, including the importance of reporting percentage of variant histology in a specific tumor because of the possible treatment implications. She briefly reviewed the latest in the rapidly progressing field of molecular classifiers. Several groups have been investigating the impact of molecular subtypes on NAC responsiveness with Seiler, Black et al Eur Uro showing that basal subtype tumors had poorer prognosis, but derived most benefit from cisplatin-based NAC. In another paper, Hedegaard described an updated classifier of NMIBC which emphasized two distinct molecular pathways: One associated with Ta tumors which looked more luminal and less likely to progress, and another signature associated with tumors with CIS histology.
3) Guidelines. Chang et al J Urol reported the new AUA guidelines with more defined risk stratification for NMIBC. New AUA MIBC guidelines emphasized NAC, consideration of bladder sparing therapy, and importance of patient support.
4) ERAS. Citing one of her own papers, Dr. Schuckman pointed out that ERAS pathways again showed improved outcomes and should be standard of care.
5) Currently open trials and anticipated results: AdIFN gene therapy in bcg unresponsive NMIBC. COXEN trial (investigating whether expression profiling can predict prognosis or response to cisplatin-based neoadjuvant chemotherapy). RAZOR (Multi-institutional randomized trial comparing open vs robotic radical cystectomy). Swog s1011 (randomized multi institutional trial comparing standard vs extended PLND during radical cystectomy).
Presented by: Anne Schuckman, MD University of Southern California
Contributed by: Jed Ferguson, MD/PhD and Ashish Kamat, MD. MD Anderson Cancer Center, Department of Urology.
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA