GENITOURINARY CANCERS

In November 2018, the FDA issued a draft guidance recommending metastasis-free survival as an endpoint in drug trials for nonmetastatic castration-resistant prostate cancer, suggesting a major change in expectations for treatment of this tumor type.

The future of prostate cancer treatment will involve using biomarkers to identify which patients will respond to which medications and applying regimens currently in use for patients with advanced disease to men with earlier-stage disease, said Howard I. Scher, MD.

Up to 30% of men with prostate cancer could meet criteria for genetic evaluation for hereditary disease. The hard part, Sanjeev Kaul, MD, said at the 2018 Large Urology Group Practice Association Annual Meeting, is separating the mutations that are relevant from those that are not.

Hormone Sensitive Metastatic Castration-Resistant Prostate Cancer

For clinicians who treat men with early-stage prostate cancer in their clinical practice, a new clinical guideline on the use of external beam radiation therapy has been developed by a panel of experts representing the American Society of Clinical Oncology, American Society for Radiation Oncology, and American Urological Association.

James L. Wade III, MD, FACP, FASCO, discusses the importance of clinical trials in the community.

Treatment Recommendations Upon Metastasis in CRPC

I think one of the most important advancements in biomedical technology that has improved our understanding of the complexities of cancer is the ability to sequence the cancer genome for any individual patient, in a rapid and cost-effective manner, to help us make treatment decisions in the clinic.

Groundbreaking developments in cancer therapies can change lives, extending survival and sending patients who previously thought their chances were slim into remission. But these therapies come at a cost, and many patients reel at the prospect of heavy financial burdens. To help patients and programs meet the challenges of affording cancer treatments, community cancer centers are expanding the role of financial advocates in their organizations.

Thomas A. Gallo, MS, MDA, president of the Association of Community Cancer Centers, discusses his mission as president to “reflect, renew, and reignite” in order to create a more resilient oncology team for the community.

Among men in the ongoing phase II TRITON2 trial with BRCA1/2 alterations, 51% had a confirmed prostate-specific antigen response to rucaparib (Rubraca), according to preliminary data reported in a poster presentation by Wassim Abida, MD, PhD, and colleagues at the 2018 ESMO Congress.

Larotrectinib induced an objective response rate of 80% in patients with advanced solid tumors who harbored&nbsp;<em>NTRK&nbsp;</em>gene fusions, according to results pooled from 3 small trials of the TRK inhibitor. Results were presented during the 2018 ESMO Congress.

According to a presentation from the ERA 223 trial atthe 2018 ESMO Congress, no improvements in survival endpoints were seen with the addition of radium-223 dichloride to abiraterone acetate and prednisone in patients with metastatic castration-resistant prostate cancer.

Rising prescription drug prices continue to add to the burden of paying for quality healthcare. In an effort to confront such costs, the Centers for Medicare &amp; Medicaid Services has rescinded a prohibition on step therapy for Medicare Advantage plans. But some contend such a policy will reduce patient access to optimal medication.

Rucaparib (Rubraca) has received a breakthrough therapy designation from the FDA&nbsp;for single-agent use in adult patients with <em>BRCA1/2</em>-positive metastatic castration-resistant prostate cancer following at least 1 androgen receptor&ndash;directed therapy and taxane-based chemotherapy.

Patients with the localized form of CRPC still have no options that are proven to extend overall survival, but preliminary results from the PROSPER trial of enzalutamide and the SPARTAN trial of apalutamide offer them unprecedented hope.