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HIGHLIGHTS FROM THE 2024 EUROPEAN SOCIETY FOR MEDICAL ONCOLOGY ANNUAL MEETING |
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Therapeutic Options Beyond AR Pathway Inhibitors: What Do We Choose Next?
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| Are Cytotoxics Still the Next Option? |
| Elena Castro, MD, Ph.D. |
| Elena Castro examined the role of cytotoxic therapies in prostate cancer (PCa) treatment post-androgen receptor pathway inhibitors (ARPI). She highlighted various treatment options across different PCa stages, such as radioligand therapy and PARP inhibitors for patients with ARPI resistance. Castro emphasized the limited efficacy of second-line ARPIs and the importance of taxanes and PARP inhibitors, particularly for BRCA-mutated patients, while noting the ongoing need for clarity in treatment sequencing, especially between ARPIs, taxanes, and radioligands. |
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| Will Theranostics Become Standard of Care?
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| Silke Gillessen MD
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| At the 2024 ESMO Annual Congress, Silke Gillessen addressed the role of theranostics in prostate cancer and its potential to become the standard of care, particularly in metastatic castration-resistant prostate cancer (mCRPC). Theranostics, which combine therapeutic and diagnostic radionuclides, have already gained widespread endorsement in clinical practice guidelines.
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| Novel Therapeutic Approaches for ARPI-Resistant Disease
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| Gerhardt Attard, MD, PhD
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| Currently, there are multiple treatments available for ARPI-resistant disease, including docetaxel, radioligand therapy, PARP inhibitors, and immune checkpoint inhibitors. The latter two are used for molecularly selected patients, while 177Lu-PSMA is used for patients selected via molecular imaging. Dr. Gerhardt Attard discussed novel therapeutic approaches for ARPI-resistant disease.
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Can We Expand Bladder Preservation by Optimal Use of Systemic Therapy and Biomarkers?
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| Could Optimal Systemic Therapy Be Adequate Without Locoregional Therapy? |
| Srikala Sridhar, MD, MSc, FRCPC |
| Srikala Sridhar explored whether optimal systemic therapy alone could effectively manage muscle-invasive bladder cancer without requiring locoregional therapy like radical cystectomy. She emphasized the potential for bladder preservation through improved systemic regimens, careful patient selection, and advanced response assessments. However, challenges such as avoiding both overtreatment and undertreatment, validating clinical response criteria, and integrating new biomarkers and imaging techniques remain crucial for advancing bladder-sparing strategies. |
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| Biomarkers and Prediction of Clinical Complete Response in Bladder Cancer |
| Eva Schaake, MD, PhD |
| Eva Schaake discussed the challenges and advances in predicting clinical complete response in bladder cancer using biomarkers. Despite the potential of genomic alterations like ERCC2 mutations and molecular subtyping to predict responses, these are not yet reliable for clinical practice. Emerging tools such as plasma ctDNA and multiparametric MRI show promise in tracking treatment response, with ctDNA being particularly useful for systemic response prediction and mpMRI for local assessment. |
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| Clinical responders: Option of Chemoradiation? |
| Leslie Ballas, MD |
| Leslie Ballas explored the role of chemoradiation for clinical responders in bladder cancer. She highlighted the benefits of neoadjuvant chemotherapy, which improves survival in bladder cancer across different treatment modalities. Despite this, evidence from trials like RTOG 89-03 and BA06 3084 indicates that NAC does not consistently enhance outcomes in trimodality therapy, which combines chemotherapy, radiation, and bladder preservation. While NAC before TMT shows promise, many studies, including a multi-institutional analysis, suggest no clear survival benefit over other therapies. |
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| The Role of Urologist in Bladder Preservation Strategies
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| James Catto, MB, ChB, PhD, FRCS(Urol)
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| James Catto emphasized the critical role of urologists in bladder preservation strategies, using "The 5 S's": Selection, Staging, Surveillance, Salvage, and Support. He highlighted the importance of proper patient selection, maximal transurethral resection of bladder tumors (TURBT), and monitoring responses to therapy. Dr. Catto also stressed the collaboration between urologists, oncologists, and advancements like mpMRI and molecular subtyping to refine treatment and follow-up strategies for bladder preservation. |
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