Dr. A. Edward Yen explores treatment de-escalation in advanced prostate cancer, emphasizing biomarkers, intermittent therapy, and strategies to reduce toxicity.
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Dr. Edward Yen reviews updates from the CheckMate 274, EV302, and NIAGARA trials in advanced urothelial cancer, highlighting ctDNA as a new biomarker tool.
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A. Edward Yen, MD, reviews recent developments in prostate cancer treatment, summarizing key trials from recent oncology meetings. He begins this 29-minute presentation by outlining the evolving treatment landscape, from localized to metastatic castration-resistant prostate cancer. The focus narrows on select phase II and III trials involving novel therapeutics and treatment strategies.
Dr. Yen begins with the BRCAAway trial, which explores abiraterone, olaparib, and their combination in patients with metastatic CRPC harboring BRCA1/2 or ATM mutations. He then moves on to the Contact-02 study, which investigates cabozantinib and atezolizumab versus second-line hormonal therapy in metastatic CRPC patients. Continuing, he shares the results of the Embark study, which examined enzalutamide with or without androgen deprivation therapy in patients with non-metastatic CRPC.
Other notable studies include a negative evaluation of metformin for preventing progression in low-risk prostate cancer and an exploratory phase I trial of a novel human kallikrein-targeted radioligand therapy. Dr. Yen concludes with an overview of ARV-766, a PROTAC androgen receptor degrader showing strong PSA responses, highlighting its potential for future development in targeting resistant androgen receptor mutations in advanced CRPC.
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A. Edward Yen, MD, discusses the importance of collaborating with medical oncologists when using hormone-directed therapy to treat metastatic prostate cancer. He begins by illustrating changes in treatment approach, using a case study to contrast past treatment algorithms with modern treatment approaches.
Dr. Yen presents a treatment algorithm from the early 2000s, calling attention to the isolation of “urologist” versus “oncologist” options in patient treatment and the impact of those isolated treatment approaches on overall survival. Dr. Yen contrasts this approach with modern agents and therapies which require collaboration between urologists, medical oncologists, and other medical disciplines.
Dr. Yen then addresses practical challenges associated with increased multidisciplinary collaboration, including keeping up with rapid advancements, managing treatment toxicities, and sequencing and selecting treatment.
Dr. Yen concludes by presenting a model of collaboration used by his practice which integrates urology, medical oncology, radiation oncology, nuclear medicine, pathology, interventional radiology, palliative/supportive care, genetics, nutrition and dietetics, psychology, and social work in treatment. He notes that the involvement of these specialties in the treatment of advanced prostate cancer leads to comprehensive evaluations, tailored treatment plans, and better outcomes for patients.
Read MoreA. Edward Yen, MD, Assistant Professor of Medicine in the Hematology and Oncology Section at Baylor College of Medicine in Houston, Texas, summarizes research on perioperative therapies for bladder cancer and how they compare to each other. He begins with an overview of the current standard of care for muscle-invasive bladder cancer (MIBC), citing a Swiss study showing that after radical cystectomy there is still a problem of incurable disease relapse through overall survival rates below 63%, and another study showing that neoadjuvant cisplatin-based chemotherapy (NAC) combinations improve survival for MIBC by 5-8%. Dr. Yen then overviews NAC, highlighting the VESPER trial that compared cisplatin-gemcitabine (GC) and dose-dense MVAC (ddMVAC) in the perioperative MIBC setting and found that more patients were able to follow through with NAC than adjuvant chemotherapy (AC) by 21%. He discusses multiple immunotherapy trials that together show that patient responses seem better with chemo-immunotherapy than they do with immunotherapy alone. Dr. Yen then reviews the CheckMate-274 trial that found that adjuvant nivolumab treatment-related adverse effects were tolerable due to a 7% rate of being severe enough to end treatment vs. a 1.4% rate in the placebo arm. He also summarizes the IMvigor trial, which did not meet its primary endpoint of disease-free survival but found that positive ctDNA patients had an improvement from atezolizumab that was not seen in other patients. Dr. Yen concludes that GC and ddMVAC remain important perioperative chemotherapy regimens, that neoadjuvant and adjuvant therapies have situational uses, and more research will be key to refining these treatments further.
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