Dean’s Digest – ASCO GU 2020

Major themes which emerged from ASCO GU 2020 included a plethora of studies utilizing various permutations of targeted therapies along with immunotherapy and/or chemotherapy in bladder, prostate and renal cell cancers (RCC) with generally modest incremental improvements reported in various clinical endpoints.

Blood based cancer component assessments, termed “liquid biopsies” were much in vogue throughout ASCO GU 2010.  Liquid biopsies include identification of intact circulating tumor cells, tumor specific cell free DNA mutations, copy number variants, methylation signatures, transcriptomics, micro RNA signatures, exosomes, microvesicles as well as tumor-educated platelets.

KIDNEY CANCER

Liquid biopsy applications within RCC. Abstracts: 721, 728, 740, 743

Nivolumab and ipilumab in first line metastatic clear cell kidney cancer, as analyzed at 42 months, now reveals a distinct tail on the survival curve of 25-30% of patients so treated. Abstract 605

COMMENTARY:  Such long-term benefit has yet to emerge from other trials including trials of checkpoint inhibitors plus TKIs, however longer follow up will be required from these studies to validate these outcome differences.  Of note however, from these same studies an early survival advantage is seen during the first 6-8 months with checkpoint inhibition plus TKI treatment of RCC which was not found with nivo plus ipi in Keynote 214 wherein the survival curves remained superimposed over the initial 6 to 12 months.  This suggests that an early response might be an advantage with checkpoint inhibition plus TKI while dual immunotherapy may allow for more durable responses.

The role of cytoreductive nephrectomy in the age of IO and TKIs for clear cell RCC Is examined. Abstracts: 608, 646, 652, 688, 703, 707, 748

Real World Evidence (RWE) is a topic of numerous abstracts in all GU malignancies:
Prostate: 29, 33, 35, 36, 41, 43, 48, 59, 223, 229
Testis: 393

Bladder: 447, 451, 452, 457, 458, 493
Kidney: 628, 639, 647, 682, 683, 709

PROSTATE CANCER

Liquid Biopsy. Abstracts: 98, 110, 147, 154, 160, 168, 170, 173, 174, 176, 180, 183, 186, 190, 200, 201
[insert Andrew Armstrong, question 1]
PARP inhibitors in prostate cancer treatment. Abstracts: 43, 118, 119, 134, 150, 178
COMMENTARY: Positive outcomes reported most significantly with BRCA 2 mutations and much less so with other DDR mutations.

PSMA based imaging in prostate cancer. Abstracts: 9, 21, 22, 23, 24, 25, 26, 292, 295, 334

PSMA targeted treatment for prostate cancer. Abstracts: 45, 99, 129,124,155

Mutational identification and prognostic implications. DDR Abstracts: 43, 63, 119, 121, 134, 172, 185, 187. BRCA Abstracts:  44,63,65,127,152,178

COMMENTARY: DNA Damage Repair (DDR) and BRCA in prostatectomy cancer was also a major center of interest.  BRCA2 germline and somatic mutations appear to predict a much higher probability of favorable response to PARP inhibitors compared to other DDR mutational events.

Radium 233 in the treatment of metastatic prostate cancer — both alone and in combination with other therapies. Abstracts: 32, 41, 47, 50, 59, 117, 121,125, 130, 136, 223, 225, 228, 236

Proton beam therapy in prostate cancer. Abstract: 305

COMMENTARY: Fascinating to see so little reporting during ASCO GU 2020 on what has been historically such a controversial topic

AR-V7 splice variant implications for prostate cancer. Abstracts: 184, 245

COMMENTARY:  AR V7 splice variant seems to be generating less interest as a specific predictive biomarker as the sequential utilization of novel antiandrogens is falling out of favor.

CAR T cell therapy studies are now accruing in metastatic prostate cancer. Abstracts: TPS 250 and TPS 266

Prostate irradiation in the setting of oligometastatic prostate cancer. Abstracts 93, 101, 116, 319

UROTHELIAL CANCERS

Liquid biopsies in bladder cancer. Abstracts: 525, 558, 565, 567, 562

Neoadjuvant treatment of muscle invasive bladder cancer. Abstracts: 439, 441, 445, 474, 505, 506, 507, 509, 522, 523, 533, 539, 540, 541, 542, 543, 547, 554, 562

FGFR mutations and treatments. Abstracts: 432, 489, 493, 510, 511, 527, 542, 565, 576

Enfortumab Vedotin in bladder cancer. Abstracts: 441, 546

TESTICULAR CANCER

Post-treatment management of residual retroperitoneal masses. Abstracts: 388, 389, 390, 391

MicroRNAs as tumor markers in testicular cancer. Abstracts 371, 375, 414, 416, 417

COMMENTARY: miRNA371a, while not yet commercially available, appears to have far greater sensitivity and specificity that the current serum tumor markers utilized in the management of germ cell tumors.

FINAL COMMENTARY: The near absence of investigations into the microbiome of patients with genitourinary malignancies was notable.  Indeed, data is now accumulating that the microbiome may play a very significant role in therapeutic outcomes from treatment in many malignancies.  Perhaps ASCO GU 2021 will provide greater illumination on this timely topic.

By Dean Gesme, MD; Immediate Past President, Minnesota Oncology

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