New Treatments May Improve Survival for People with Genitourinary Cancers

2018 Genitourinary Cancers Symposium
February 5, 2018
Monika Sharda, ASCO staff

The 2018 Genitourinary Cancers Symposium begins this week in San Francisco, February 8th to the 10th. This scientific meeting is an opportunity for national and international experts to exchange ideas about how to improve the treatment of cancers that affect the genitourinary (GU) system, including bladder cancer, kidney cancer, and prostate cancer.share on twitter You can learn more about research from this symposium by following the #GU18 hashtag on Twitter.

Below are summaries of 4 studies that will be presented at the symposium:

  • Immunotherapy Added to Standard Treatment Slows Growth of Advanced Kidney Cancer

  • New Drug Delays Development of Metastatic Prostate Cancer

  • Adding Docetaxel to Hormone Therapy Improves Quality of Life For Men With Prostate Cancer

  • New Way to Predict Survival for People With Bladder Cancer

Immunotherapy Added to Standard Treatment Slows Growth of Advanced Kidney Cancer

Renal cell carcinoma is the most common type of kidney cancer in adults, making up about 85% of kidney cancer diagnoses. When this cancer spreads to other parts of the body, it is called metastatic renal cell carcinoma. The first treatment option for this type of metastatic cancer is usually a targeted therapy, such as sunitinib (Sutent).

Now, a study suggests that a drug called atezolizumab (Tecentriq) given in addition to a targeted therapy called bevacizumab (Avastin) can be more effective than treatment with only sunitinib. Atezolizumab is a type of immunotherapy called an immune checkpoint inhibitor, which works by taking the brakes off the body’s immune system. Atezolizumab blocks a protein called PD-L1 on the surface of tumor cells, allowing the immune system to recognize and destroy those cells. Bevacizumab and sunitinib are targeted therapies that block the growth of blood vessels to the tumor to limit its growth. 

This study included 915 adults who had not previously received treatment for metastatic renal cell carcinoma. The participants were grouped based on whether each person’s tumor cells had PD-L1. During the study, they received either the combination of drugs through an intravenous (IV) tube every 3 weeks or took a sunitinib pill daily for 4 weeks then 2 weeks off treatment.

What does this mean?

Researchers found that atezolizumab plus bevacizumab delayed cancer growth for more than 3 months longer than sunitinib for the PD-L1-positive group.share on twitter Side effects were also less frequent and less severe with the combination treatment. Forty percent of the people taking the combination treatment experienced treatment-related side effects compared with 54% of the people taking sunitinib.

“For an aggressive cancer like this, where less than 20% of people survive 5 years after diagnosis, we think a 3.5 month longer progression-free survival, given the tolerability for this new combination treatment regimen, is an important development.”

— lead study author Robert J. Motzer, MD
Memorial Sloan Kettering Cancer Center
New York

New Drug Delays Development of Metastatic Prostate Cancer 

Results from a phase III clinical trial found that a drug called apalutamide can delay the development of metastatic cancer in men with non-metastatic castration-resistant prostate cancer.

The study, called SPARTAN, included 1,207 men who were at high risk for developing metastatic prostate cancer. In addition, they all had cancer that had stopped responding to androgen deprivation therapy (ADT). ADT is a hormonal therapy used to treat prostate cancer recurrence in many men. When a prostate cancer no longer responds to ADT, the prostate cancer is called castration resistant.

The men in the study received ADT and apalutamide or ADT and a placebo. A placebo is an inactive drug or treatment used in a clinical trial to help compare treatments. Results of the study were that apalutamide lowered the risk of metastasis and death by 72% when compared with the placebo group. Men who received apalutamide also lived about 2 years longer than those in the placebo group. In general, apalutamide did not have serious side effects. And quality of life for the men on the medicine was similar to other men with prostate cancer.

What does this mean?

Currently, there are no FDA-approved treatments for men with non-metastatic castration-resistant prostate cancer, estimated to be about 100,000 men in the United States.share on twitter If further studies find apalutamide to be promising, the drug could become an effective option to treat non-metastatic castration-resistant prostate cancer and delay the development of metastatic cancer. 

“Until this trial, there have been no drugs proven to benefit men with non-metastatic prostate cancer that has progressed despite standard hormonal therapy. These results show that apalutamide made a significant difference in prolonging the time before the development of metastasis.”

— lead study author Eric J. Small, MD, FASCO
University of California
San Francisco 

Adding Docetaxel to Hormone Therapy Improves Quality of Life For Men With Prostate Cancer

Data from an ongoing clinical trial has shown that adding the drug docetaxel (Docefrez, Taxotere) to hormone therapy for advanced prostate cancer improves quality of life and delays the need for another treatment.share on twitter

This study is a new analysis of an ongoing clinical trial named Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE), which has collected information on the more than 9,000 men with advanced prostate cancer participating in the study since it began in 2005. For this analysis, researchers looked at information on quality of life from 592 men who had either metastatic or non-metastatic cancer.

To measure quality of life, researchers asked participants to rate various aspects of their health on a scale of 1 to 5. The aspects were:

  • Mobility

  • How well they could care for themselves

  • How well they could perform daily activities

  • Pain and discomfort

  • Anxiety and depression

Then they used this information to predict how long a person would live using a measurement called quality-adjusted life years (QALY). QALY measures a person’s quality and quantity of life. By using this type of measurement, researchers found that the men with metastatic prostate cancer taking docetaxel plus hormone therapy could potentially live almost 11 months longer with a good quality of life for at least 6 months when compared with men receiving standard treatment. Researchers also found that men with non-metastatic prostate cancer who were taking docetaxel and hormone therapy could potentially live a little more than 9 months longer with a good quality of life for almost 5 months when compared with men receiving standard treatment.

What does this mean?

It was previously known that docetaxel could lengthen survival of men with metastatic prostate cancer, but the information about non-metastatic disease may help doctors in their efforts to reduce recurrence. In addition to possibly offering a better quality of life than standard treatment, docetaxel plus hormone therapy is a less costly option for men with non-metastatic prostate cancer due to the reduction in the need for additional treatment. In the study, adding the chemotherapy reduced the need to be treated later for recurrence by 40%.

“How does one measure wanting to live a few more months to see a grandchild born even if the therapy results in difficult side effects? Although there is a concern about side effects, primarily nausea and fatigue, it is clear that avoiding or delaying recurrence outweighs the upfront toxicity of chemotherapy and adds enough to overall quality of life so that using docetaxel is beneficial.”

— lead study author Nicholas D. James, MD, PhD
University of Birmingham
United Kingdom

New Way to Predict Survival for People With Bladder Cancer

Researchers have created a new method to predict how long people with bladder cancer will live if they are receiving an immunotherapy drug called atezolizumab (Tecentriq).

To develop this method, researchers used data from 2 clinical trials with a total of 405 participants treated with atezolizumab to see which medical factors were more closely linked to overall survival. This information helped them establish 6 factors that they used to calculate the overall survival:

  • How well a person can perform daily activities, often called “performance status”

  • Whether the cancer has spread to the liver

  • Number of platelets, which are the cells that help the blood to clot

  • Inflammation

  • Tissue damage

  • Anemia, which is a low level of red blood cells

What does this mean?

This new method could help doctors figure out which people with bladder cancer would benefit more from adding atezolizumab to their treatment plan.share on twitter Further research is planned to help confirm the findings of this new model, which could eventually help doctors decide which immunotherapy option is best for each person.

“In just the past few years, the U.S. Food and Drug Administration has approved 5 new immunotherapies for urothelial cancers. Based on the rapid availability of new therapies, we thought it was important to try to assess which patients might benefit the most from atezolizumab, which is 1 type of these new therapies. We believe we’ve developed the first prognostic model that, once confirmed in larger studies, could provide a critical decision-making tool for clinicians.” 

— lead study author Gregory Pond,
PhD McMaster University
Ontario, Canada

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