Emerging strategies and controversial topics in advanced...
Transcript of Emerging strategies and controversial topics in advanced...
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Cinzia Ortega Oncologia
ASLCN2 Alba-Bra
Emerging strategies and controversial topics
in advanced prostate cancer: Highlights
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Outline
• Emerging Immunotherapy Strategies for Castrate Resistant Prostate Cancer
• Management of Oligometastatic Prostate Cancer From Imaging to Therapy
• Abstract 165: The FALCON trial – impact of 18F-fluciclovina PET/CT on clinical management choices for men with biochemically recurrente prostate cancer
• Local Treatment in Patients with Newly Diagnosed Metastatic Disease - Debates on Controversial Topics in Prostate Cancer (ARS)
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Outline
• Emerging Immunotherapy Strategies for Castrate Resistant Prostate Cancer
• Management of Oligometastatic Prostate Cancer From Imaging to Therapy
• Abstract 165: The FALCON trial – impact of 18F-fluciclovina PET/CT on clinical management choices for men with biochemically recurrente prostate cancer
• Local Treatment in Patients with Newly Diagnosed Metastatic Disease - Debates on Controversial Topics in Prostate Cancer (ARS)
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Immune Checkpoint Inhibition in Prostate Cancer
Presented By Fatima Karzai at 2018 Genitourinary Cancers Symposium: Translating Evidence to Multidisciplinary Care (Modified)
• Two negative ipilimumab phase 3 studies
• No data supporting anti PD-1/PD-L1 monoterapy in PC
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Presented By Padmanee Sharma at 2018 Genitourinary Cancers Symposium: Translating Evidence to Multidisciplinary Care
IPI drives T cell responses
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Slide 17
Presented By Padmanee Sharma at 2018 Genitourinary Cancers Symposium: Translating Evidence to Multidisciplinary Care
IPILIMUMAB enhances PD-L-1 and VISTA expression in PC
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Presented By Padmanee Sharma at 2018 Genitourinary Cancers Symposium: Translating Evidence to Multidisciplinary
Care
IPI-NIVO Combo
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To Sergio Bracarda
• Immunotherapy in PC: low mutational load Could it be a potential good treatment?
• When immunotherapy in PC continuum?
• Endpoint: long responders?
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Outline
• Emerging Immunotherapy Strategies for Castrate Resistant Prostate Cancer
• Management of Oligometastatic Prostate Cancer From Imaging to Therapy
• Abstract 165: The FALCON trial – impact of 18F-fluciclovina PET/CT on clinical management choices for men with biochemically recurrente prostate cancer
• Local Treatment in Patients with Newly Diagnosed Metastatic Disease - Debates on Controversial Topics in Prostate Cancer (ARS)
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Oligometastatic PC
1) UPFRONT
2) AT RECURRENCE
Oligometastatic prostate cancer is defined as up to five
extrapelvic lesions on conventional imaging.
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Oligomets PC at RECURRENCE
Using Advanced PET Imaging to Detect Extrapelvic Disease in Patients with PSA Recurrences
Presented By Felix Feng at 2018 Genitourinary Cancers Symposium: Translating Evidence to Multidisciplinary Care
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Presented By Eugene Teoh at 2018 Genitourinary Cancers Symposium: Translating Evidence to Multidisciplinary Care Abs 165.Bottomley, oral presentation, ASCO GU 2018
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The FALCON trial (NCT02578940)
Presented By Eugene Teoh at 2018 Genitourinary Cancers Symposium: Translating Evidence to Multidisciplinary Care
85 pts median PSA at recurrence 0.63 ng/ml
Abs 165.Bottomley, oral presentation, ASCO GU 2018
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Which is the best treatment approach for oligometastatic disease ?
Presented By Felix Feng at 2018 Genitourinary Cancers Symposium: Translating Evidence to Multidisciplinary Care
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Therapeutic Options
Presented By Elisabeth Heath at 2018 Genitourinary Cancers Symposium: Translating Evidence to Multidisciplinary Care
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Oligo-recurrent/upfront PC Node and mets directed therapy
• Retrospective studies (2012-2017)
• Few patients (19 - 66 pts)
• Different oligometastatic diseases
• SRBT +/- ADT
• Different endpoints
LOCAL CONTROL AT 2 yrs 100%
Presented By Felix Feng at 2018 Genitourinary Cancers Symposium: Translating Evidence to Multidisciplinary Care
(modified)
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Many Trials for Metastases-Directed Therapy
Presented By Felix Feng at 2018 Genitourinary Cancers Symposium: Translating Evidence to Multidisciplinary Care
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LOCAL OPTIONS for Oligomets upfront PC Prostate directed therapy
HYPOTHESIS: A combination of primary tumor treatment, metastasis-directed therapy, and systemic therapy can potentially delay disease progression or in some cases be curative.
POTENTIAL BENEFITS OF RADICAL PROSTATECTOMY
• RP decreases:
– tumor burden
– disease-related morbidity
– need for palliative surgical intervention
• Increases time to development of CRPC
• improves PFS and cancer-specific survival (CSS) outcomes.
Ahmad, Oncology, nov 2017
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LOCAL OPTIONS for Oligomets upfront PC Prostate directed therapy
Summary of Prostate-Directed Therapy
Presented By Felix Feng at 2018 Genitourinary Cancers Symposium: Translating Evidence to Multidisciplinary
Care
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RT + ADT
Presented By Elisabeth Heath at 2018 Genitourinary Cancers Symposium: Translating Evidence to Multidisciplinary Care
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Presented at 2018 Genitourinary Cancers Symposium: Translating Evidence to Multidisciplinary Care
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Conclusions
• The definition of oligometastatic remains undefined
• Superior imaging is challenging the traditional paradigm based on conventional imaging.
• Such patients may be considered for aggressive approaches, including radical treatment of the primary cancer.
• Nonrandomized data suggest a survival benefit for patients who undergo treatment of the primary despite metastatic disease at diagnosis.
• Treatment of the primary in men with oligometastatic disease should be considered experimental.
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• Clinical parameters
– Bone mets
– Visceral mets
• Disease parameters
– Gleason score
– Tumor burden low vs high
– M0 vs M1
CHAARTED High volume
Visceral mets and/or ≥ 4 bone mets (at last 1 beyond pelvis and vertebral column)
STAMPEDE ABI All
METASTATIC AT PRESENTATION
LATITUDE 2 or 3 HIGH RISK criteria Bone mets > 3 Gleason score > 8 Visceral mets
Oligometastatic PC upfront: population
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To Sergio Bracarda
• The traditional approach to metastatic PC (systemic ADT) was challenged by the findings of the CHAARTED, STAMPEDE, and LATITUDE trials
• Considering results and OS obtained with ABI and DOCE in metastatic PC upfront setting, is the option to treat primary tumor reinforced?
• A more aggressive treatment?