Session 2:
Next Generation Developments in GU Cancer

2018 Consensus Statements

  1. Trials ongoing for adjuvant therapy in high-risk renal cancer, with current tyrosine-kinase inhibitors (TKIs), are investigating only progression-free survival (PFS) as primary endpoint. We think overall survival (OS) is a more important indicator of outcome. The group questioned the clinical significance of an improvement in PFS with significant toxicity, without a benefit in survival. Quality of life changes become more relevant especially in a patient who starts treatment without symptoms. This is particularly important in light of the known toxicities of tyrosine kinase inhibitors in this setting.

  2. The CARMENA trial found, in intermediate to high risk patients with metastatic disease, that patients treated with nephrectomy followed by sunitinib had an inferior survival than patients undergoing treatment with sunitinib alone. The group agreed that more studies are needed to evaluate nephrectomy several patient groups 1) low-risk metastatic renal patients undergoing either TKI or immune therapy and 2) Intermidiate/high risk patient metastatic patients undergoing immune therapy.

  3.  Neoadjuvant trials are currently being performed with immunotherapy alone or the combination of immunotherapy with targeted therapies. The optimal combination and timing in relationship to surgery are yet to be defined. Is the neoadjuvant approach better than that adjuvant approach? Does neoadjuvant therapy proved a constant source of antigen exposure for immune therapy, and thus have an advantage over adjuvant therapy?

  4. The role of biomarkers, particularly PDL-1 status needs to be better defined. Is PDL 1 expression predictive of response or prognostic for survival, or both? Can this marker be used to design neoadjuvant/adjuvant trials.

5-Year Predictions:

  1. Combination antiangiogensis therapy/checkpoint inhibition therapy will be a standard of care for metastatic disease.
  2. Neoadjuvant/adjuvant immune therapy trials will be completed.

Session Moderator

Daniel P. Petrylak, MD

Yale Cancer Center
New Haven, CT

ABOUT THE AUTHOR

Daniel P. Petrylak, MD

Daniel P. Petrylak, MD, leads the genitourinary cancers medical oncology team at Smilow Cancer Hospital as director of the genitourinary cancer research group, professor, and co-director of the Cancer Signaling Network program. Dr. Petrylak joined Yale from Herbert Irving Cancer Center at Columbia University Medical Center with New York-Presbyterian Hospital, where he served as Professor of Medicine (Medical Oncology) and Urology and began his appointment in September of 2012. Dr. Petrylak is a member of the American Association for Cancer Research (AACR), American Society for Clinical Oncology (ASCO), American College of Physicians (ACP), American Association for the Advancement of Science (AAAS), American Urological Association (AUA), and the Southwest Oncology Group (SWOG). After serving for more than 20 years as the advanced bladder chair for SWOG, Dr. Petrylak is now the Vice Chair of the Genitourinary Committee. He additionally has led multiple national and international studies in prostate and bladder cancer.

Dr. Petrylak’s research interests span both prostate and bladder cancer. He led an investigator-initiated trial of docetaxel and estramustine in castration resistant prostate cancer. The results of this study supported a phase 3 trial of this combination in SWOG led by Dr. Petrylak, which in turn, supported the FDA approval of docetaxel for castration resistant prostate cancer. This was one of the first two trials to demonstrate a survival benefit in this state of disease. Dr. Petrylak has also been instrumental in the development of immunotherapy and targeted therapies for refractory bladder cancer. His work with Enfortumab Vedotin has supported the accelerated and full FDA approval of this drug.

Dr. Petrylak received his undergraduate degree from Columbia College and his medical degree from Case Western University School of Medicine. He completed his internship and residency at Albert Einstein College of Medicine and his fellowship in medical oncology at Memorial Sloan-Kettering Cancer Center. He has authored more than 200 peer-reviewed articles and book chapters on prostate and bladder cancer research outcomes.