After the intensity of gastrointestinal cancer, we now turn our attention to genitourinary (GU) cancers with the upcoming ASCO GU meeting later this week in Orlando.
Two of the big topics here will be prostate and renal cell (RCC) cancers.
Unfortunately, the long awaited data in adjuvant RCC demonstrated that early treatment with sorafenib or sunitinib did not improve outcomes in locally advanced kidney cancer after resection. According to the ASCO press release, the trial conducted by Dr Haas and colleagues at U Penn discovered that:
“The average period to disease recurrence was similar between those who received sorafenib or sunitinib after surgery (5.6 years) and those treated with placebo (5.7 years).”
We will therefore turn our attention to castration resistant prostate cancer (CRPC).
One of the recent and ongoing controversies is splice variants, especially AR-V7, which is thought by some research groups to confer resistance to the hormonal therapies, enzalutamide and abiraterone. The big question though, is does it, and how useful is an assay in helping to determine appropriate therapy? Are there other factors at play?
We looked at the latest data and put the findings in context with what we know from other published research.
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Chicago: The ASCO 2014 conference is in full swing as it enters day 3. We’re continuing our coverage of the meeting with our daily live blog where we post regular updates of data that catches our interest or quick notes from sessions we’ve been to.
What have been the highlights so far – well the AZD9291 vs. CO-1686 debate is keeping the analysts busy. I interviewed Dr Pasi Jänne yesterday about the AZD9291 data and will be talking with Dr Lecia Sequist later today to talk about CO-1686. Meetings such as ASCO do afford the opportunity to talk to thought leaders.
What’s on the agenda this morning?
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Over the last few years we have seen new therapies emerge for the treatment of advanced prostate cancer from immunotherapy to chemotherapy and second generation hormone therapies. Each of these has increased survival and outcomes. Along the way though, a host of other agents have fallen by the wayside with a raft of negative phase III trials that did not live up to their phase II promise. These include atrensentan, dasatinib, ipilimumab, lenalidomide and more recently, custirsen.
Much of the focus has, however, been on the hormonal drugs, abiraterone (Zytiga) and enzalutamide (Xtandi) in both the pre and post chemotherapy settings. One thing has become clear though – over time the responses attentuate as resistance sets in. This is very common with oral therapies.
Some big questions to consider here are:
- What causes it?
- How can we overcome adaptive resistance?
- Would combination approaches produce synergistic results?
- Or should we consider new targets with a different mechanism of action (MOA)?
The answers to these questions are now being eagerly explored through basic, translational and clinical research. I was very impressed with the quality of research and breadth of fresh ideas and approaches emerging from the SBUR, SUO and UOR sessions at AUA this year, including new combination trials already in the planning phase.
In the past, Bertrand Tombal (Belgium) talked about the Grand Cru year for clinical research in CRPC. In the future we may well look back at 2014 as a similar Grand Cru year for basic research for prostate cancer, if the findings translate to clinic. The bench-to-bedside process is very much alive and well in urologic research.
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