Raadpleeg ook literatuurlijst niet-toxische middelen en behandelingen specifiek bij blaaskanker van arts-bioloog drs. Engelbert Valstar

1 juni 2020: ASCO 2020: 

Hier een aantal aanbevolen abstracten specifiek voor blaaskanker en urinewegkanker   en zaadbalkanker en een studie bij peniskanker van ASCO 2020. Klik op de nummers voor de studiepublicaties en presentaties

Aanbevolen door Prof. Dr. Tom Guzzo

Session: Genitourinary Cancer—Kidney and Bladder

Bladder Cancer

5031.100 Assessing the potential cost-effectiveness of the addition of atezolizumab to first-line platinum chemotherapy in advanced urothelial cancer: Implications for value-based pricing. AR Khaki, LN Diamantopoulos, et al

Take-Home Message

  • The authors conducted a cost-effective analysis comparing the use of platinum-based chemotherapy (PBC) alone and PBC plus atezolizumab among patients with advanced urothelial cancer. The incremental cost-effectiveness ratio (ICER) of PBC plus atezolizumab compared with PBC alone was $629,755 per life-year and $895,800 per quality-adjusted life-year (QALY). For PBC plus atezolizumab to be cost-effective at an ICER of $150,000 per QALY, there would need to be a 33% reduction in the cost of atezolizumab.
  • At the present cost, the combination of PBC plus atezolizumab does not appear to be cost-effective for the first-line treatment of advanced urothelial cancer.

5033.102 Early response marker during pembrolizumab treatment in metastatic urothelial cancer: Temporal shift in peripheral CD4 T cells expressing chemokine receptors. M Rijnders, HE Balcioglu, D Robbrecht, et al

Take-Home Message

  • Patients with platinum-resistant metastatic urothelial cancer treated with pembrolizumab were followed to identify potential predictive biomarkers to aid patient selection. The frequency of CXCR3+ CD4 T cells decreased during treatment in responders and increased drastically in nonresponders. In addition, responders had a decreased frequency of CD4 T cells co-expressing CXCR3 and CCR1 prior to treatment. There was a decrease in frequency of CD4 T cells expressing chemokine receptors and in the frequency of CD4 T cells expressing the co-inhibitory receptor PD-1 on treatment in responders and an increase in the frequency of CD4 T cells expressing the co-stimulatory receptor 4-1BB.
  • Dynamic phenotyping, which can identify patients with effective immune activation, may be helpful to identify patients with metastatic urothelial cancer who may benefit from pembrolizumab treatment.

5036.105 Impact of renal impairment on clinical outcomes in patients (pts) with locally advanced or metastatic (LA/M) urinary tract carcinoma (UTC) treated with atezolizumab (atezo): Analysis of the international SAUL study. M Retz, F Seseke, GL Banna, et al

Take-Home Message

  • Patients with locally advanced or metastatic urinary tract carcinoma treated with atezolizumab until disease progression or toxicity were followed. Due to a reduced creatinine clearance (CrCl) rate, 47% of patients were deemed to be ineligible for either chemotherapy or cisplatin. The rate of grade ≥3 adverse events was around 45%, regardless of the CrCl rate. The objective response rate was 13% in those with a CrCl rate of 15–29 mL/min, 15% in those with a CrCl of 30–59 mL/min, and 13% in those with a CrCl ≥60 mL/min. The median overall survival was 5.7 months, 8.5 months, and 9.4 months, respectively.
  • Patients with renal impairment and metastatic urinary tract carcinoma considered ineligible for chemotherapy or cisplatin can safely be treated with atezolizumab.

5050.119 Clinicogenomic predictors of extreme responses to anti-PD1/PDL1 checkpoint inhibitors (CPI) in metastatic urothelial cancer (mUC). MY Teo, K Whiting, JM Mota, et al

Take-Home Message

  • Patients with metastatic urothelial cancer treated with anti–PD-1/PD-L1 checkpoint inhibitors (CPI) underwent tumor sequencing with MSK-IMPACT to evaluate clinical and genomic predictors of response. Factors associated with a shorter time on treatment (ToT) were liver metastases, prior chemotherapy, and high neutrophil count. Factors associated with a longer ToT were DNA damage repair–gene alterations, urethral primary, and higher BMI, eosinophil count, hemoglobin, and tumor mutation burden. No specific genomic alterations showed a significant association with outcomes.
  • The authors identified clinical and genomic factors that impact outcomes in this population.

5087.156 Comprehensive genomic profiling (CGP) of histologic subtypes of urethral carcinomas (UrthCa). P Grivas, JM Jacob, O Shapiro, et al

Take-Home Message

  • Comprehensive genomic profiling was completed on 127 urethral carcinoma samples to evaluate genomic alterations (GAs). The most prevalent potentially targetable GA was seen in PIK3CA. There was also an identified GA in the mTOR pathway and other potentially targetable genes. Higher tumor mutational burden was observed in urothelial and clear cell carcinomas compared with adenocarcinomas and squamous cell carcinomas.
  • GAs in patients with advanced urethral carcinoma may predict the potential benefit of targeted and immune therapies, and this may be useful in future trials of adjuvant and neoadjuvant therapy.

TPS5091.160 A phase III randomized study of neoadjuvant chemotherapy (NAC) alone or in combination with nivolumab (NIVO) ± linrodostat mesylate, followed by adjuvant postsurgical NIVO ± linrodostat, in cisplatin-eligible muscle invasive bladder cancer (MIBC). G Sonpavde, A Necchi, S Gupta, et al

Take-Home Message

  • Adults with previously untreated muscle-invasive bladder cancer are currently being enrolled in this phase III study and will be randomized to receive cisplatin-based neoadjuvant chemotherapy (NAC) alone (arm A), NAC plus nivolumab (arm B), or NAC plus nivolumab plus linrodostat (arm C) prior to radical cystectomy. Immuno-oncologic therapy will be continued after surgery in the arms B and C.
  • The primary endpoints of this study are pathologic complete response after neoadjuvant therapy and event-free survival.

E17002 Comparison of oncologic outcomes for robotic-assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) among locally advanced and node-positive patients: An analysis of the National Cancer Database (NCDB). AG Reddy, AD Sparks, C Darwish, et al

Take-Home Message

  • Patients with locally advanced or node-positive bladder cancer who underwent robotic-assisted radical cystectomy (RARC) or open radical cystectomy (ORC) were retrospectively assessed to compare outcomes. RARC was associated with improved survival, lower 30- and 90-day mortality, fewer positive margins, and shorter surgical inpatient stay compared with ORC. However, following adjustment for confounding covariates, the only difference between the two cohorts was length of inpatient stay. RARC was associated with higher lymph node yield compared with ORC.
  • RARC does not appear to be less safe than ORC. Further randomized trials are required to evaluate the potential benefit of RARC over ORC.

E17010 Functional outcomes of older adults treated with radical cystectomy for muscle-invasive bladder cancer. CK Osterman, AM Deal, KA Nyrop, et al

Take-Home Message

  • Patients with muscle-invasive bladder cancer (MIBC) were followed to compare outcomes following radical cystectomy in older patients (aged ≥70 years) and younger patients (aged <70 years). Older patients were less likely to receive neoadjuvant chemotherapy (NAC) than younger patients despite the clinical stage at presentation being comparable in the two groups. Physical function measures at baseline were similar, but 1 month post RC, older patients had lower clinician- and patient-rated Karnofsky Performance Status (KPS) and a greater decline in KPS score from baseline compared with younger patients. After 3 months, all measures of physical function in older patients were back to baseline function.
  • Older patients with MIBC experience a short-term functional decline after radical cystectomy, but recovery back to baseline levels is achieved within 3 months.

E17013 Evaluation of mood disorders in bladder cancer patients and their primary caregivers. D Au, C Chestnut, A Brevik, et al

Take-Home Message

  • Patients with bladder cancer and their primary caregivers participated in individual interviews, and patients underwent chart review to evaluate the prevalence of mood disorders. Symptoms of depression were noted in 49% of patients and 33% of caregivers. There was an inverse relationship between income and depression symptoms in the patient and caregiver.
  • Depression is prevalent among patients with bladder cancer, and symptoms of depression, but not anxiety, often correlate between patient and caregiver. Multiple factors may impact mood, including financial pressure and the psychosocial effects of cancer and treatment.

E17014 Small Cell Bladder Cancer: Treatment Patterns and Clinical Outcomes. RR Sekar, LN Diamantopoulos, F Vakar-Lopez, et al

Take-Home Message

  • Patients with small cell bladder cancer (SCBC) treated at a single institution were retrospectively reviewed to compare outcomes in those treated with radical cystectomy (RC) or concurrent chemoradiotherapy (CCRT). The median overall survival was not significantly different in the two groups. The rate of pathologic complete response among patients in the RC group treated with neoadjuvant chemotherapy was 20%. Both median overall survival (OS) and progression-free survival were significantly shorter in patients with SCBC treated with RC compared with patients with conventional urothelial carcinoma treated with RC. SCBC was associated with a significantly shorter OS compared with conventional urothelial carcinoma.
  • Among patients with SCBC, outcomes are similar with RC and CCRT but are significantly worse than those seen in patients with conventional urothelial carcinoma.

E17018 Predicting residual tumor for T1 high-grade bladder urothelial carcinoma before second transurethral resection specimens. A Takeuchi, M Shiota, J Inokuchi, et al

Take-Home Message

  • Urine cytology was taken from 50 patients with T1 high-grade bladder urothelial carcinoma between first and second transurethral resection (TUR). Residual tumor on the second TUR was observed in 20 patients. Positive urine cytology between the first and second TUR and multiple TUR chips containing lamina propria invasion were significant predictors of residual tumor on second TUR.
  • Second TUR could potentially be avoided in select patients with T1 high-grade bladder urothelial carcinoma with careful evaluation of urine cytology.

E17029 Oncologic outcomes of complete transurethral resection prior to neoadjuvant chemotherapy for muscle-invasive bladder cancer. JS Pak, CR Haas, HV Reyes, et al

Take-Home Message

  • Patients with clinically localized muscle-invasive bladder cancer treated with complete transurethral resection (TURBT) prior to neoadjuvant chemotherapy (NAC) were retrospectively reviewed to evaluate outcomes. Following NAC, patients underwent repeat TURBT or radical cystectomy, and patients refusing radical cystectomy were placed on an active surveillance/delayed intervention protocol. Pre-NAC complete TURBT was performed in 67% of patients, and these patients were more likely than those without pre-NAC complete TURBT to achieve a durable complete response and durable down-staging. In addition, pre-NAC complete TURBT was associated with improved 5-year overall survival.
  • Pre-NAC complete TURBT was associated with improved outcomes and survival in this population, and this approach should be considered when possible to optimize outcomes.

E17031 Long-term outcomes among BCG-treated high-risk non-muscle invasive bladder cancer patients in an equal access setting. SB Williams, L Howard, M Foster, et al

Take-Home Message

  • Patients with high-risk non–muscle invasive bladder cancer (HR NMIBC) treated within Veterans Affairs centers with at least one dose of bacillus Calmette-Guérin (BCG) were followed to describe real-world outcomes and the economic burden of treatment. Carcinoma in situ (CIS) with or without T1 or TaHG was observed in 17% of patients; 83% had TaHG or T1 but no CIS. Patients with CIS appeared to have a worse prognosis than those without CIS. Most patients (90%) received six BCG installations within 1 year, and the median all-cause per patient expenditure was $358,593.
  • Most patients with HR NMIBC received six installations of BCG over a 1-year period, and treatment was associated with considerable cost.

E17033 Sarcomatoid urothelial carcinoma: Oncologic outcomes from a tertiary center and SEER-Medicare data. RR Sekar, LN Diamantopoulos, AR Khaki, et al

Take-Home Message

  • Data from the SEER-Medicare database were combined with data from a single institution to evaluate outcomes among patients with sarcomatoid urothelial carcinoma (SUC) treated with radical cystectomy (RC). Patients with SUC had higher rates of pT3/4 disease at the time of RC and lower rates of complete pathologic response after neoadjuvant chemotherapy (NAC) compared with patients with conventional UC (CUC). Median overall survival (OS) was 20 to 21 months in patients with SUC versus 121 months in patients with CUC. There was no significant difference in OS in patients with SUC treated with RC only or with RC plus NAC.
  • SUC was associated with poor survival outcomes, and the addition of NAC to RC did not improve survival.

E17049 Is it necessary to obtain a second review on outside pathology for patients referred with non-muscle invasive (NMI) bladder cancer? J Brown, C Hensel, J He, et al

Take-Home Message

  • The authors reviewed 75 initial pathology specimens from patients with non–muscle invasive bladder cancer who underwent resection of bladder tumors at external facilities before referral to the cancer institute, which allowed repeated reading of the pathology specimens. There was relatively high agreement in reporting tumor grade and moderate agreement in microscopic extent between the referring center and the cancer institute. There was no comment made on lymphovascular invasion in 58.7% of outside reports. Of low-risk patients, 6 of 12 were upstaged to intermediate-risk, 2 of 11 intermediate-risk patients were upstaged to high-risk, and 6 of the 46 patients judged to be high-risk were upstaged to muscle-invasive disease.
  • Many patients with pathology evaluation completed at an outside center were upstaged on review, and reports were often lacking minimum College of American Pathology criteria. Review of outside pathology should be considered on referral as there may be significant implications for treatment planning.

Germ Cell/Testicular Cancer

5052.121 Multicenter analysis of serum tumor markers, treatment patterns, and relapse in patients with testicular cancer in clinical stage IS. F Zengerling, P Paffenholz

Take-Home Message

  • Patients with testicular germ cell tumors (TGCT) in clinical stage IS (CSIS) were followed to evaluate treatment and outcomes. False CSIS was defined as classification with CSIS but with serum tumor markers returning to normal after orchiectomy. Of 2616 patients evaluated, 43 patients were classified as having CSIS. Of these 43 patients, 63% were true and 37% were false. The relapse-free survival was 88.9% at 5 years and 77.8% at 10 years. All relapses were treated with bleomycin, etoposide, and cisplatin, and there were no recorded deaths.
  • Fewer than 2% of all cases of TGCT were classified as CSIS. The relapse-free survival was favorable in this group.

5056.125 Persistence of platinum in semen of cisplatin-treated survivors of advanced testicular cancer. ER Malone, JH Lewin, L Wang, et al

Take-Home Message

  • A cohort of 38 testicular cancer survivors treated with cisplatin was followed to evaluate the persistence of platinum in semen and the association with fertility. At a median of 14 months following treatment completion, the median semen platinum concentration was 0.5 ng/mL, but semen platinum levels at this time were significantly higher than blood platinum levels drawn at the same time. Semen platinum levels were associated with time since last dose, but the cumulative cisplatin dose did not correlate with semen platinum levels.
  • Platinum can be detected in the semen of men following treatment with cisplatin for well over a year. Further studies are warranted to evaluate the relationship between elevated semen platinum and fertility.

5053.122 Outcome of men with HIV-associated germ cell cancer: Results from an international collaborative study. M Hentrich, M Bower, G Daugaard, et al

Take-Home Message

  • Men with HIV-associated germ cell cancer (HIV-GCC) were followed to evaluate outcomes. Over 80% of patients were treated with combined antiretroviral therapy (cART). Median follow-up was 6.5 years. The progression-free survival rate was 81% at 5 years and 73% at 10 years, and the overall survival rate was 91% at 5 years and 85% at 10 years.
  • Survival outcomes for patients with HIV-GCC are favorable and comparable with those of HIV-negative patients with GCC, and the management of these 2 groups should be identical.

Other GU Cancer

5088.157 Impact of human papillomavirus (HPV) infection on the outcome of perioperative treatments for penile squamous-cell carcinoma (PSCC). P Giannatempo, M Bandini, Y Zhu, et al

Take-Home Message

  • Patients with penile squamous cell carcinoma (PSCC) who underwent inguinal lymph node (ILN) dissection were followed to evaluate treatment options for those with HPV+ PSCC. Factors associated with overall mortality included pathologically involved ILN ratio (ILNR) and extranodal extension but not HPV status. However, among patients treated with perioperative radiotherapy, HPV+ status was associated with favorable overall mortality and negative vascular invasion. There was a significant interaction between HPV+ status and increasing ILNR on overall mortality.
  • Patients with HPV+ PSCC appear to respond well to perioperative radiotherapy, and further prospective studies are warranted.

E17111 Trends in the use of administrative databases in urologic oncology: 2000-2019. Z Leopold, P Dave, A Menon, et al

Take-Home Message

  • The authors analyzed the trends in the use of administrative databases (AD) in published manuscripts in urologic oncology from 2000 to 2019. The compound annual growth rate of publications using ADs was 18.7%, with the highest contribution seen from the SEER database. Over half the publication were prostate cancer studies. The median impact factor of journals publishing these studies was 2.78. Over half the AD manuscripts were published by urologists, while epidemiologists published 18.2% and radiation oncologists published 10.6%.
  • There has been substantial growth in the use of ADs for research in genitourinary oncology. Factors influencing this are increasing competition to secure funding, large sample sizes available, and good database quality. Continued improvements in data capture will benefit future research.

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