Genitourinary Cancers

There has never been a referendum on IL-2. True, in the era of paradigm-shifting therapies, IL-2 may be overlooked at times, but it must not be excluded from the conversation.

Unfortunately, although agents in the pipeline each extend life, none are curative. Therefore, physicians who investigate and treat mCRPC have two paths they can follow to further improve outcomes.

Ultimately, as agents in both VEGF-targeted and immunotherapy classes with lower toxicity rates are developed, questions of combination and sequence will inspire clinical investigations of strategies that, it is hoped, will maximize both the quantity and quality of life for patients with RCC. Melanoma therapy drug development continues to lead the way with regard to what is therapeutically possible with immunotherapy-and suggests that HD IL-2 continues to be relevant in today’s treatment landscape.

Node-positive prostate cancer without distant metastases (T any, N+, M0) currently is encountered rarely, primarily because of the shift to diagnosis at earlier stages, a result of widespread PSA testing.

In this review, we focus on the testosterone/androgen receptor pathway that is being targeted with potent new agents; we also discuss other important alternative biologic pathways that have given rise to new therapeutics that may attenuate prostate cancer growth, survival, and propagation.

The “experts” should maintain a stringent standard regarding what merits further development and reconsider carefully and critically the available data before committing to PARP inhibition, attacks on the PI3K pathway, and vasoactive agents in prostate cancer.

Current evidence for the management of lymph node–positive prostate cancer suggests both a disease-control and survival benefit to systemic ADT plus surgery and radiation.

In this review, we examine the currently approved options available for these disease processes, including the newer agents and selected combinatorial approaches under investigation, and we attempt to identify the role of high-dose IL-2 in the context of current clinical practice.

From 2004 to 2009, use of advanced treatment technologies increased among prostate cancer patients with low-risk disease and high risk of noncancer mortality.

Bone metastases result in poorer outcomes for those patients with advanced renal cell carcinoma (RCC), who were treated with a molecularly targeted therapy. The results were presented in two separate analyses at the annual ASCO meeting.

A new imaging approach, combining PET with magnetic resonance (MR), was shown to be more sensitive in detecting recurrent prostate cancer compared with PET/CT.

In a new study presented at the Endocrine Society’s annual meeting, researchers using animal models show that early BPA exposure increases prostate cancer risk.

The mTOR inhibitor everolimus failed to prove progression-free survival noninferiority compared with the VEGF-targeting tyrosine kinase inhibitor sunitinib when given as first-line treatment in patients with metastatic renal cell carcinoma.

Researchers observed durable responses in patients with renal cell carcinoma treated with the PD-L1 antibody MPDL3280A. The study, which was presented at the 2013 ASCO Annual Meeting, was one of the few immune therapy trials that allowed patients with non-clear cell histologies and some clinical activity was observed in these patients.

Recent studies suggest patients with bladder cancer are not receiving optimal care or the follow-up surveillance as recommended by the National Comprehensive Cancer Network (NCCN).

Surveillance of patients with stage I seminoma following orchiectomy can spare a majority of patients from adjuvant chemotherapy with a low risk of relapse, according to results presented at the 2013 ASCO meeting.

A new study shows that men diagnosed with prostate cancer may do better by substituting carbohydrates and saturated fats with plant-based fats such as those found in nuts and olive oil.

In my experience, being treated for low-volume Gleason 6 tumors is the norm, not the exception, for men in the United States. Surveillance may be discussed as an option, but it is not taken seriously.

The concept of active surveillance is based on the observation that Gleason 6 (pattern 3) prostate cancer is an indolent condition that poses little or no threat to the patient’s life. Conservative management is thus appropriate for these patients.

Further analyses of data subsets from the ALSYMPCA study of the alpha particle-emitting isotope Ra-223 (Xofigo) were presented at ASCO, providing additional evidence of efficacy and safety of the recently FDA approved therapeutic agent.

Addition of curcuminoids to treatment with docetaxel was well tolerated and showed promise in improving the response rate to docetaxel “in terms of both PSA decrease and objective response” in a phase II trial in patients with castration-resistant prostate cancer.

Monotherapy with enzalutamide (Xtandi) achieved a “high PSA response rate and marked PSA decline” in patients with hormone-naïve prostate cancer after 6 months in a single-arm, multicenter phase II study.

Treatment with 200 µmol per day of sulforaphane for 20 weeks was “feasible, safe,” and inhibited histone deacetylase (HDAC) function in a single-arm study of 20 patients who had non-castrate biochemical (PSA)-recurrence of prostate cancer despite surgery or radiation.

Ahead of the 2013 ASCO meeting we highlight some of this year's prostate cancer sessions, many of which focus on how best to use the new agents that have been approved recently, as well as looking into new drugs and combinations presented from early trials.

The use of cannabis among men has been linked to a significantly decreased risk for bladder cancer, according to a recent study; however, no cause and effect association has been found.