ASCO GU Roundup: A Comprehensive Overview

The Genitourinary Cancers Symposium took place Thursday, January 25, 2024, to Saturday, January 27, 2024, in San Francisco, California. Posters and presentations revealed the latest updates across kidney, bladder, and prostate cancer research. 

Immunotherapy took center stage, with findings from the phase 3 AMBASSADOR Alliance A031501 (NCT03244384) and KEYNOTE-564 (NCT03142334) trials. Findings from a phase 2 trial (NCT03012321) of olaparib (Lynparza) plus abiraterone (Zytiga) and prednisone in metastatic castration-resistant prostate cancer (mCRPC) with BRCA1/2 or ATM alterations were also highly anticipated.

Here are some of the highlights from the 3-day event.

Kidney Cancer

Kidneys, adrenal glands, genitourinary system: © Leo Viktorov - stock.adobe.com

• Subcutaneous Nivolumab Delivers Clinical Equipoise to Standard IV Dosing in ccRCC
  • Subcutaneous nivolumab (Opdibo) coformulated with recombinant human hyaluronidase PH20 delivered better exposure vs intravenous nivolumab in patients with progressive advanced or metastatic clear cell RCC (ccRCC). 
• Adjuvant Pembrolizumab Notably Improves OS vs Placebo in ccRCC
  • Therapy with adjuvant pembrolizumab (Keytruda) significantly improved overall survival (OS) compared with placebo in patients with ccRCC.
• Adjuvant Nivolumab Falls Short of Disease-Free Survival End Point in Locally Advanced High-Risk RCC
  • Adjuvant monotherapy with nivolumab failed to achieve the primary end point of disease-free survival (DFS) in comparison with a placebo for patients with localized RCC at a high risk of relapse following nephrectomy. 
• Real-World Data Show RCC Type and Tumor Stage Advises on Recurrence
  • Real-world, retrospective data showed that morphologic RCC types and tumor-stages helps to inform recurrence and prognosis.
• Pembro/Lenvatinib Shows Sustained Antitumor Activity, Prolongs Survival in nccRCC
  • Pembrolizumab plus lenvatinib (Lenvima) in the first-line continued to demonstrate antitumor activity and led to longer survival rates vs historical controls in patients with advanced RCC.
• Lenvatinib/Pembrolizumab Shows Positive Trends vs Global SOC in Frontline RCC Meta-Analysis
  • The combination of lenvatinib and pembrolizumab as first-line treatment in patients with advanced RCC demonstrated similar OS and improved progression-free survival (PFS) and response rates compared with global standard-of-care immunotherapies.
• Belzutifan Boosts QoL, Delays Disease Progression in Advanced Kidney Cancer
  • Belzutifan (Welireg) treatment resulted in longer time to disease progression and improvements in quality-of-life (QoL) scores in patients with advanced/metastatic ccRCC compared with everolimus.

Bladder Cancer : © SciePro - stock.adobe.com

Bladder Cancer

• Adjuvant Pembrolizumab Shows Clinically Significant DFS Benefit in Urothelial Carcinoma
  • Interim results showed that adjuvant pembrolizumab confers a statistically significant and clinically meaningful DFS benefit compared with observation across patients with muscle-invasive and locally advanced urothelial carcinoma (UC), irrespective of PD-L1 status.
• Enfortumab Vedotin With Pembrolizumab Shows Consistent OS Advantage in Urothelial Carcinoma
  • Enfortumab vedotin-ejfv (Padcev) plus pembrolizumab continued to exhibit consistent OS and PFS benefits vs chemotherapy across patients with previously untreated locally advanced or metastatic UC.
• Pembrolizumab/Cabozantinib is an Effective First-Line Therapy in Advanced mUC
  • The PemCab trial (NCT0334804) which explored the efficacy and safety of pembrolizumab and cabozantinib (Cabometyx) as first-line treatment for advanced UC showed that the combination was effective for both cisplatin-eligible and cisplatin-ineligible patients.
• Nadofaragene Firadenovec: Significance of uMRD-Negative Status in Achieving Recurrence-Free Outcomes in NMIBC
  • In patients with non-muscle-invasive bladder cancer unresponsive to Bacillus Calmette-Guérin who underwent nadofaragene firadenovec (Adstiladrin) treatment, those who achieved urinary minimal residual disease-negative status showed no recurrences.

Conceptual image for prostate cancer treatment, 3D illustration showing destruction of a tumor inside prostate gland: © Dr_Microbe - stock.adobe.com

Prostate Cancer

• Significance of Early Genetic Testing in HRR-Mutated mCRPC Highlighted by Real-World Observations
  • An examination of real-world data involving individuals with metastatic castration-resistant prostate cancer (mCRPC) characterized by homologous recombination repair (HRR) mutations and treated with olaparib (Lynparza) underscored the importance of implementing earlier and more consistent genetic testing.
• Olaparib Plus Abiraterone Continues to Show Consistent Clinical Benefits in Post-Hoc Analysis for HRR-Mutated mCRPC
  • Administering frontline olaparib alongside abiraterone acetate resulted in a statistically significant and clinically meaningful advancement in radiographic PFS and OS compared with the combination of placebo and abiraterone acetate in patients diagnosed mCRPC carrying prevalent HRR mutations.
• Analysis of Subsequent Therapies Confirms OS Benefit of Darolutamide in mHSPC
  • A post hoc analysis supported the OS benefit of adding darolutamide (Nubeqa) to androgen deprivation therapy (ADT) plus docetaxel in patients with metastatic hormone-sensitive prostate cancer (mHSPC).
• Darolutamide Combined with ADT Prior to RP Demonstrates Safety and Efficacy in Prostate Cancer
  • A therapy plan comprising preoperative darolutamide alongside ADT for 6 months, succeeded by radical prostatectomy, proved to be both safe and effective for individuals diagnosed with locally advanced prostate cancer.
• High-Dose Radiation Plus Long-Term ADT Improves Survival in High-Risk Prostate Cancer
  • Utilizing a higher dose of radiation therapy in combination with the long-term use of ADT improved survival outcomes after 10 years of follow-up in patients with high-risk prostate cancer.
• Enhanced Progression-Free Survival: Cabozantinib Combination Outperforms NHT in Metastatic CRPC
  • The combination of cabozantinib and atezolizumab (Tecentriq) showcased a noteworthy and statistically significant enhancement in PFS when contrasted with second-line novel hormonal therapy in individuals dealing with mCRPC. 
• Abiraterone, Prednisone, Apalutamide Improves Prostate Cancer Outcomes, Leaves HRQoL Unaffected
  • Treatment consisting of salvage radiation and GnRH agonist with abiraterone acetate plus prednisone (AAP) and apalutamide (Erleada) after radical prostatectomy improved oncological outcomes without causing significant differences in health-related QoL vs bicalutamide (Casodex) in patients with prostate cancer.
• Olaparib Plus Abiraterone/Prednisone Improves Survival in mCRPC
  • Olaparib in combination with abiraterone and prednisone significantly improved PFS in mCRPC harboring BRCA1/2 or ATM alterations compared with monotherapy with either agent.
• Prior ERBT Did Not Increase Hematological Toxicity in Ra-223-Treated mCRPC
  • Prior treatment with external beam radiation therapy did not increase relative incidence of hematological toxicity among patients with mCRPC treated with radium-223.
• HRRm Tester Underutilized for mCRPC in the Real-World Setting
  • Routine germline and somatic testing are standards of care for all patients with mCRPC; however, only approximately 40% of patients underwent this kind of testing.
• Adding Darolutamide to ADT May Reduce Hospitalizations But Longer Stays in mHSPC
  • Treatment with darolutamide for mHSPC was associated with a lower rate of hospitalization, but a longer length of stay compared with treatment with placebo.