Genitourinary Cancers

Despite the common use of postoperative radiotherapy (RT) in patients managed initially with radical prostatectomy (RP), a number of questions remain. Raldow and colleagues build their arguments around three randomized trials that indicated a significant benefit of immediate adjuvant radiotherapy in patients with high-risk features.

Listen to internationally regarded oncologist and clinical investigator, Robert J. Motzer, MD, attending physician at Memorial Sloan-Kettering Cancer Center, discuss the past, present, and future trends in renal cell carcinoma.

In this exclusive ASCO podcast, Andrew J. Armstrong, MD, ScM, Assistant Professor of Medicine and Surgery Duke Comprehensive Cancer Center, Departments of Medicine and Surgery, Divisions of Medical Oncology and Urology, addressed the vexing clinical issue of chemotherapy’s limited effectiveness in advanced renal cell carcinoma.

Once PSA kinetics were thought to be a good way to predict which patients with early prostate cancer were at risk of progression. Now they're not. Even those who had the most hope for these biomarkers have evidence of their unreliability for this purpose.

Prostate cancer patients administered high doses of proton-beam therapy appear to have a markedly reduced risk of disease recurrence when compared with other low-risk patients treated with conventional radiation therapy, according to two recent studies.

Renal cell carcinoma represents 3% of all cancer cases but has a significant death rate associated with it: It’s estimated that there will be 60,000 new cases this year and 16,000 deaths from kidney cancer. The risk factors associated with kidney cancer include smoking, obesity, hypertension, and some occupational exposure.

A 56-year-old woman was referred to our institution for a left nephroureterectomy after the diagnoses of a nonfunctioning left kidney and noninvasive papillary urothelial carcinoma of the distal left ureter (Ta grade 1). Following the procedure, surveillance cystoscopy and computed tomography (CT) scan of the abdomen and pelvis demonstrated a large bladder tumor with pan-urothelial extension.

The National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology for Non-Hodgkin’s Lymphomas (NHL) have been updated to include ofatumumab (Arzerra) and romidepsin (Istodax). Ofatumumab was added to the NCCN Guidelines as a treatment option for relapsed/refractory disease in patients with chronic lymphocytic leukemia, with and without a 17p deletion. In addition, the updated guidelines include romidepsin as a systemic treatment option for patients with mycosis fungoides and Szary syndrome.

The first major study to address the cardiovascular adverse effects of endocrine therapy for prostate cancer could change attitudes toward treatment options because testosterone deprivation may have more impact on the patient’s life than it does on the androgen receptor.

GlaxoSmithKline has received FDA approval for pazopanib (Votrient) for the treatment of patients with advanced renal cell carcinoma. The FDA’s approval of the angiogenesis inhibitor was based on data from a phase III clinical trial, which demonstrated that pazopanib reduced the risk of tumor progression or death by 54% compared with placebo and regardless of prior treatment.

The US Food and Drug Administration approved GlaxoSmithKline’s pazopanib (Votrient), the sixth drug to be approved for kidney cancer since 2005.

The comparison of brachytherapy and surgery may be done on several levels. This review focuses the comparison on toxicity, the “soft” endpoints of biochemical relapse-free survival and clinical relapse-free survival, and the “hard” endpoint of prostate cancer–specific mortality.

Standard treatment options for prostate cancer patients include surveillance, surgery, external-beam radiotherapy, brachytherapy, the combination of external-beam and brachytherapy, and the combination of radiotheraputic modalities with hormonal therapy, for appropriately chosen patients.

In this review, we summarize contemporary data pertaining to active surveillance, a safe and appropriate strategy for select patients with low-risk cancer characteristics who undergo monitoring at regular intervals.

The Association of Community Cancer Centers recently surveyed its members and found a universal request for assistance in developing prostate cancer care programs. The ACCC responded by setting up pilot programs in the U.S. that focus on the following areas:

A phase III trial demonstrated that denosumab can reduce fracture risk in men with nonmetastatic prostate cancer undergoing androgen deprivation therapy, Amgen announced.

Avastin (bevacizumab) plus interferon-alfa has been approved for the treatment of metastatic renal cell carcinoma, according to Genentech. Approval was based on phase III data from the AVOREN study, which showed a 67% increase in progression-free survival (10.2 months) compared to those who received interferon-alfa alone (5.4 months; hazard ratio = 0.60).

Young men with advanced forms of prostate cancer do not live as long as older men with similar forms of the disease, according to research conducted at the University of Washington in Seattle.

Prostate cancer remains the most common solid organ malignancy diagnosed among men in the United States, with the American Cancer Society estimating that 1 in 6 men will be diagnosed with prostate cancer, and 1 in 35 will die of the disease.[1]

So here we go again with one more round in the battle of treatment options for localized prostate cancer. While more than 3 decades of such sparring has gotten us no closer to evidence-based conclusions, one might say that these matches do serve the purpose of bringing out the best and the worst of the therapeutic contenders.

Ferring Pharmaceuticals announced that the US Food and Drug Administration (FDA) has approved the trade name Firmagon (degarelix for injection) for its prostate cancer treatment previously marketed under the generic name degarelix.

In 2008, approximately 186,000 American men were diagnosed with prostate cancer, resulting in about 28,600 deaths.[1] It is the most commonly diagnosed cancer, and second only to lung cancer as the leading cause of cancer death in men.

The optimal treatment for clinically localized prostate cancer is an ongoing subject of controversy.[1] As pointed out by Drs. Mirhadi and Sandler, no randomized trial has compared radical prostatectomy (RP) to radiation therapy (RT), and no study has definitively “proven” the superiority of one technique over the other. Therefore, we disagree with the author’s conclusion that RT “is the ‘only way to go’ when managing early-stage prostate cancer.”

For the September and October issues of ­ONCOLOGY, we have assembled a team of experts in the diagnosis and management of early-stage prostate cancer-ie, disease that has not clinically metastasized at first presentation, and which is theoretically curable-and have asked them to take a position on optimal patterns of care.

Prostate cancer experts agree on one issue: No single treatment can be considered universal for men diagnosed with prostate cancer. There are myriad choices and considerations to be reviewed with every diagnosis. In addition, there are conflicting data about when, or if, men require screening for prostate cancer as well as when to start therapy for confirmed disease.

Patients with advanced renal cell carcinoma who were treated with sunitinib malate (Sutent) experienced a median overall survival of more than two years, compared with patients who took interferon-alpha, according to Pfizer.

Crawford and Hou[1] review the data on luteinizing hormone-releasing hormone (LHRH) antagonists in prostate cancer. They describe the results of a phase III trial comparing monthly degarelix to monthly leuprolide in men with advanced prostate cancer. Degarelix treatment was associated with a more rapid decline of serum testosterone, and was not associated with an initial surge of serum testosterone seen during the first few days of treatment with leuprolide. They discuss the role of this new form of medical gonadal suppression for the treatment of prostate cancer.

The recent US Food and Drug Administration (FDA) approval of degarelix, a luteinizing hormone-releasing hormone (LHRH) antagonist, has renewed interest in this class of drugs as a prostate cancer therapy. Approval was based on a prospective phase III trial of 610 patients randomized to one of two dosing schedules of degarelix, or standard-of-care monthly leuprolide acetate monotherapy, with initial antiandrogen therapy allowed at the treating physician’s discretion for prevention of clinical flare.[1]

Drs. Crawford and Hou provide an important clinical introduction to a novel class of hormonal agents that have been under development for several decades for the treatment of advanced and metastatic prostate cancer.

Physicians have known since 1941 that testosterone suppression benefits patients with symptomatic metastatic prostate cancer.[1] The pioneering study in this regard showed that estrogen therapy achieved comparable efficacy to castration by improving acid and alkaline phosphatase levels associated with relief of cancer-related symptoms. More than 6 decades later, however, many of the therapies subsequently developed for achieving androgen deprivation still suffer from serious limitations.