Robert Dreicer, MD, MS, MACP, FASCO

University of Virginia Comprehensive Cancer Center

Charlottesville, Virginia

Robert Dreicer, MD, MS, MACP, FASCO, is the Associate Director for Clinical Research and the Deputy Director of the University of Virginia Comprehensive Cancer Center in Charlottesville, Virginia. He serves as Section Head of Medical Oncology and Co-Director of the Paul Mellon Urologic Institute. He is also a Professor of Medicine and Urology at the University of Virginia School of Medicine. He previously served as Chair of the Department of Solid Tumor Oncology at the Cleveland Clinic. Dr. Dreicer is board-certified in internal medicine and oncology and he specializes in the management of genitourinary malignancies, as well as the design and conduct of clinical trials in urologic oncology. Dr. Dreicer received his BS from Colorado State University and his MS from the University of Texas Graduate School of Biomedical Science in Houston, Texas. He received his MD from the University of Texas Medical School in Houston before completing an internal medicine residency at Indiana University in Indianapolis. He then went on to a medical oncology fellowship at the University of Wisconsin Carbone Clinical Cancer Center in Madison, Wisconsin. Dr. Dreicer has published widely in genitourinary oncology and served as principal investigator of a large number of studies in genitourinary neoplasms. He served as Co-chair of the National Cancer Institute Genitourinary (NCI GU) Steering Committee from 2012-2018 and is a member of the editorial board of the New England Journal of Medicine Journal Watch Hematology/Oncology and the American Board of Internal Medicine (ABIM) Medical Oncology Longitudinal Test Assessment Committee.

Disclosures:

Talks by Robert Dreicer, MD, MS, MACP, FASCO

Updates in Treatment of Renal Cell Carcinoma

Posted by Robert Dreicer, MD, MS, MACP, FASCO | Dec 2021

Robert R. Dreicer, MD, MS, MACP, FASCO, Associate Director for Clinical Research and the Deputy Director of the University of Virginia Cancer Center, discusses the challenges in picking an optimal front-line regimen for the treatment of renal cell carcinoma and the impact of adjuvant immuno-oncology (IO) therapy. He cites data from four trials (CheckMate 214, Keynote-426, CheckMate 9ER, and CLEAR) before outlining the challenges in choosing an optimal front-line regimen. Dr. Dreicer points out that there is no comparative data currently available before explaining that tyrosine kinase inhibitors (TKIs, formerly the standard of care for kidney cancers) are toxic, challenging drugs that impact a patient’s quality of life. Dr. Dreicer outlines the therapies available today, including ipilimumab plus nivolumab (IPI-NIVO) which he characterizes as challenging for the first couple of months but well-tolerated in the last ~20 months during which patients undergo a maintenance regimen of nivolumab. He points out that treatment can be stopped after two years for patients that respond well. Dr. Dreicer asserts there is no equivalent conclusion with a TKI checkpoint. Dr. Dreicer then turns his discussion to the KEYNOTE-564 study on pembrolizumab versus placebo as post-nephrectomy adjuvant therapy for patients with renal cell carcinoma. He outlines the study design and eligibility criteria before displaying the disease-free survival (DFS) data showing the adjuvant therapy resulted in a 32 percent reduction in recurrence or death. Dr. Dreicer argues that for patients who can access an IO-based regimen, IPI-NIVO should be the standard of care, advising that while there is not one “right answer” to the optimal treatment question, practitioners ought to use one regimen, figure out what it’s toxicities are, and learn how to use it well. Dr. Dreicer then outlines questions that will emerge if an adjuvant checkpoint inhibitor becomes a standard of care, citing disruption to the front-line paradigm, the role of subsequent IO therapy, progression while on adjuvant therapy, and progression following adjuvant therapy. Dr. Dreicer emphasizes the need for other trials and the need to develop therapeutics that work in immune-checkpoint resistance.

Neoadjuvant Cisplatin-Based Chemotherapy for Muscle-Invasive Bladder Cancer

Posted by Robert Dreicer, MD, MS, MACP, FASCO | Mar 2021

Robert Dreicer, MD, MS, MACP, FASCO, Associate Director for Clinical Research and the Deputy Director of the University of Virginia Cancer Center, discusses phase 3 study evidence in support of cisplatin-based chemo which he argues is a secure alternative to immune-checkpoint inhibition, a more experimental treatment. He begins by paralleling support of immune-checkpoint inhibition to other oncological examples of physician claims of “I already know the answer.” Dr. Dreicer reflects on the 90s, specifically on the recommendation of high dose chemo for advanced breast cancer prior to the completion of studies. Once the studies were completed it became clear that high dose chemo did not demonstrate an improvement in treatment and may in fact have proved itself mostly harmful. He continues by reviewing a randomized trial comparing long-term survival results of patients treated with gemcitabine plus cisplatin against methotrexate, vinblastine, doxorubicin, and cisplatin in patients with bladder cancer. The trial found that cisplatin-based chemo had a 15.3% response rate. Dr. Dreicer overviews a phase 3 trial which found that cisplatin-based therapy reduced risk of death by 16%, corresponding to an increase in 10-year survival from 30% to 36%. He concludes with an argument for cisplatin-based treatment due to the availability of higher-quality evidence for its use than immune-checkpoint inhibition.