S. Rottey MD, PhD

Appropriateness of treatment options in patients with metastatic castrationresistant prostate cancer with a focus on radium-223: outcomes of a Belgian multidisciplinary Consensus Meeting

SUMMARY

The treatment landscape for metastatic castration-resistant prostate cancer (mCRPC) has changed dramatically with the approval of a variety of therapeutic agents including abiraterone acetate, cabazitaxel, docetaxel, enzalutamide and radium-223 dichloride and the introduction of docetaxel and abiraterone acetate in combination with androgen deprivation therapy in newly diagnosed metastatic prostate cancer. Evidence on the optimal sequence of these therapies is scarce. In practice, the most appropriate treatment (sequence) depends on patient and disease characteristics. This article summarises the recommendations of a multidisciplinary group of Belgian experts in sequencing treatments for patients with mCRPC, with a focus on radium-223 dichloride.

(BELG J MED ONCOL 2019;13(6): 240–250)

Highlights in genitourinary cancers

From June 1^st till June 5^th, Chicago was host for the 55^th annual ASCO meeting. This report will highlight the most important studies concerning genitourinary cancers presented during the meeting.

Merkel cell carcinoma and immune Checkpoint inhibition: where do we stand now?

Immune checkpoint inhibition (ICI) has been acknowledged as a breakthrough treatment in multiple advanced cancer types. This is also the case in metastatic Merkel Cell Carcinoma (MCC), a disease that is historically associated with a poor prognosis. Recently, several randomized trials demonstrated superior results of ICI compared to chemotherapeutic agents in patients with metastatic MCC, with less toxicity, an increased overall survival (OS), and more durable responses. Therefore, ICI is now generally considered as a new standard treatment option in this setting.

Highlights in genitourinary cancers

From the 19^th till the 23^rd of September, Munich was host for the 2018 ESMO Congress. The central theme of the congress was ‘Securing access to optimal cancer care’. This year’s venue was attended by more than 25,000 registered attendees. This report will highlight 10 key studies concerning genitourinary cancers presented during the meeting.

MRI in prostate cancer diagnosis, surgical or radiation treatment, focal therapy, active surveillance and follow-up

Serum prostate-specific antigen, digital rectal examination and transrectal ultrasound, supplemented with biopsy, are conventionally used for the screening, diagnosis, staging and surveillance of prostate cancer (PCa). However, their sensitivity and specificity are limited with diagnosis of clinically insignificant cancer and a potential risk of overtreatment as a result. Multiparametric MRI combines anatomical and functional pulse sequences, including diffusion-weighted imaging and dynamic contrast-enhanced MRI, and has evolved out of its limited role in PCa staging. The ability to visualise the prostate accurately and to detect or exclude clinically significant PCa makes multiparametric MRI a great tool to improve the diagnosis, staging, treatment planning and follow-up of patients with PCa. Multiparametric MRI can rule out clinically significant PCa and therefore has the potential to reduce the need for biopsies or to determine whether active surveillance or immediate treatment is appropriate.

(BELG J MED ONCOL 2018;12(7):313–318)

Emerging concepts in urothelial cancer

Treatment for urothelial cancer has undergone rapid change. Cisplatin based chemotherapy should be given in the neo-adjuvant setting in muscle invasive bladder cancer and could play a role in trimodality therapy when combined with surgery and radiotherapy. Genetic profiling has differentiated several subtypes of urothelial cancer, mimicking progress seen in breast cancer. Of these subtypes, p53 like tumours are less likely to respond to neo-adjuvant chemotherapy. In metastatic urothelial cancer, systemic immunotherapy (checkpoint inhibitors) has shown promising results in first line and second line patients. In a phase III trial, pembrolizumab, an anti-PD1 (programmed cell death 1) antibody, showed a survival benefit in second line metastatic urothelial cancer and should be the new standard of care. In patients who are cisplatin ineligible checkpoint can be used in first line, but no phase III data are available.

(BELG J MED ONCOL 2018;12(5):212–217)

Highlights in genito-urinary cancers

From June 1^st till June 5^th, Chicago was host for the 54^th ASCO annual meeting. The theme for this year’s venue was ‘Delivering Discoveries: Expanding the Reach of Precision Medicine’. With more than 32,000 oncology professionals from around the world to discuss state-of-the-art treatment modalities, new therapies, and ongoing controversies in the field; this year’s meeting was a great success. This report will highlight 11 key studies concerning genitourinary cancers presented during the meeting.