From the Desk of the Editor: Volume 2, Issue 3
Petros Grivas’ cover article, Updates on Immunotherapy for Urothelial Cancer, not only succinctly reviews the five new approved immuno-oncology therapies (IO), aka checkpoint (PD pathway) inhibitors and their milestone clinical trials, but also offers guidance regarding treatment selection strategy as well as IO selection within the context of chemotherapeutic options. Additionally, he discusses a basis for monitoring efficacy of response, potential biomarkers and genomic markers predictive of patient benefit and also reviews the ongoing possibilities for combination strategies. Clearly, both advanced bladder and kidney cancer care information and subsequent management decisions are evolving at a breakneck pace. The ultimate benefit will allow clinicians to offer personalized, precision therapeutic paradigms as opposed to the historic one size fits all approaches.
This issue’s Expert Commentary by Charles Ryan, The Five Take Home Messages of the LATITUDE and STAMPEDE Studies, deftly reviews the notable trial differences between LATITUDE and STAMPEDE regarding combination strategy of ADT and abiraterone acetate (Abi)/prednisone for castration naïve patients. Additionally, he offers review and reflection regarding this ADT + Abi strategy versus a chemohormonal approach. Dr. Ryan assesses 5 lessons from the recent trial literature for the newly diagnosed advanced prostate (PCa) patient:
1) Is early intervention with combination therapy better for advanced PCa patients and which specific patient populations?
2) How can we assess the benefits of combined therapies and how long should we recommend a specific therapy?
3) Despite the recent highly positive phase III trials for this patient population, we still face patient populations with poorly differentiated,resistant disease whom receive marginal benefit from combination therapy, and thus how do we best identify and manage their disease?
4) Recognizing that both intrinsic and acquired mutational selection pressures will occur after initiating early combination therapies, how can we address both treatment and trial selection for these patients, especially after they develop CRPC?
5) If a patient benefits from chemohormonal therapy, what benefit can they expect from combination androgen inhibition therapeutic strategies? Ultimately, patient care will be optimized from clinicians dedicated to reviewing the rapidly emerging data and then from those who can skillfully communicate the unfolding options, thereby truly offering the vaunted goal of shared physician/patient decision-making.
In concluding this month’s issue, we provide the Spotlight section, which is focused on the 2017 ESMO meeting held this September in Madrid, Spain. This year’s meeting covered numerous abstracts focused on urological and oncological state-of-the-art presentations regarding combination strategies for advanced PCa patients as well as burgeoning information on IO therapeutics.
Additionally, this year marks Everyday Urology-Oncology Insights, first time coverage and attendance at the Canadian Urological Association (CUA) 2017, where over 40 abstracts were published including a presentation by Dr. Kim Chi, Liquid Biopsy in Personalizing Castration-Resistant Prostate Cancer (CRPC) Therapy, evaluating the recent updates regarding interpretation and utilization of liquid biopsy for CRPC patient care.
Please enjoy the 3rd issue of 2017 and thank you for your readership and feedback.
Neal Shore,MD,FACS