Prof. Enrico Cortesi

Azienda Ospedaliera Policlinico Umberto I

Sapienza, Università di Roma

CRITICAL REVIEW Kidney Cancer

Prostate Cancer Urothelial Cancer

GU cancers highlights: Summary

• Multimodal approach in kidney and urothelial cancer

• Lack of predictive factors for immunotherapy and parp inhibition

• Some predictive factors (FGFR alterations)

Are these trials results practice changing?

Highlights … in clinical practice

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Pembrolizumab in monoterapia…

…nell’era delle COMBO IO+IO o IO+Tki…

ORR: IMDC Categories ORR by PD-L1 Expression

Presented By D.F. McDermott at 2018 ASCO Annual Meeting

Response Rates in Front Line metastatic ccRCC <br />(all risk groups)

Presented By Elizabeth Plimack at 2018 ASCO Annual Meeting

…ma Tki o IO in monoterapia hanno meno tossicità delle COMBO

Data with single agents first-line PD-1/PD-L1 inhibitors in ccRCC

Presented By Toni Choueiri at 2018 ASCO Annual Meeting

<br /><br /><br />NCCN Guidelines for RCC Treatment <br />

Presented By Ulka Vaishampayan at 2018 ASCO Annual Meeting

Current Sequence Choices<br />Powles et al. Eur Urol 2018

Presented By Ulka Vaishampayan at 2018 ASCO Annual Meeting

Pembrolizumab

Current Treatment Sequences in Advanced RCC

Presented By Ulka Vaishampayan at 2018 ASCO Annual Meeting

VS

Linee Guida Rene - AIOM 2017

Decisions Regarding Front line Therapy

Presented By Ulka Vaishampayan at 2018 ASCO Annual Meeting

Presented By Toni Choueiri at 2018 ASCO Annual Meeting

CARMENA: Prospective, multicenter, open-label, randomized, phase 3 non-inferiority study

Presented By Arnaud Mejean at 2018 ASCO Annual Meeting

Quale spazio avrà la nefrectomia della malattia metastatica ?

L’importanza del Team multidisciplinare

• Monoterapia con Pembrolizumab in 1L è una valida alternativa nei pazienti con mRCC soprattutto nei pazienti con intermediate/poor risk

• Pembrolizumab ha un profilo di tossicità limitato rispetto alle COMBO

• Costi limitati rispetto alle Combo

• Il ruolo della nefrectomia va valutato in MDT

• Necessità di studi di sequenza per categoria di rischio

TAKE HOME MESSAGE – KIDNEY CANCER

Learning Objectives

Presented By Neeraj Agarwal at 2018 ASCO Annual Meeting

Carcinoma della Prostata Ormono-Sensibile: indicazioni terapeutiche

Carcinoma della Prostata Castration-Resistant: Nuovi Farmaci

Presented By Rahul Aggarwal at 2018 ASCO Annual Meeting

Al momento non c’è spazio nella pratica clinica per i PARPi, dati immaturi, necessari biomarcatori!!!

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Presented By Ravi Madan at 2018 ASCO Annual Meeting

Qual è il ruolo dell’immunoterapia nel Ca Prostata?

Presented By Ravi Madan at 2018 ASCO Annual Meeting

• Nella malattia ormono-sensibile lo standard of care è Docetaxel + ADT o ABI + ADT in attesa di nuovi studi

• PARPi: necessario studio di fase III in subset di popolazione

• Sipuleucel-T al momento è l’unico immunoterapico (vaccino) che migliora OS nei pazienti con mCRPC

• I dati sull’utilizzo di CPI (Pembro) sono ancora immaturi

TAKE HOME MESSAGE – Prostate Cancer

CPI in Cisplatin Refractory Disease

Presented By Sandy Srinivas at 2018 ASCO Annual Meeting

Il ruolo dell’immunoterapia

Presented By Plimack at 2018 ASCO Annual Meeting

vs Best Chemotherapy Regimen: CARBO/GEM ORR 36%; PFS 5.8 m; OS 9.3 m

And more confusing when we look at the single arm first line trials updated at ASCO18

Presented By Elizabeth Plimack at 2018 ASCO Annual Meeting

On Friday, EMA restricted use in Europe

Beyond PDL1 as a biomarker

Presented By Sandy Srinivas at 2018 ASCO Annual Meeting

Beyond PDL1 as a biomarker

Presented By Sandy Srinivas at 2018 ASCO Annual Meeting

Nuove prospettive terapeutiche

Slide 2

Presented By Matt Galsky at 2018 ASCO Annual Meeting

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Presented By Matt Galsky at 2018 ASCO Annual Meeting

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Presented By Matt Galsky at 2018 ASCO Annual Meeting

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Presented By Matt Galsky at 2018 ASCO Annual Meeting

Slide 19

Presented By Elizabeth Plimack at 2018 ASCO Annual Meeting

Neoadjuvant Checkpoint Inhibition in Bladder Cancer: Early Results of Phase II Trials

Presented By Elizabeth Plimack at 2018 ASCO Annual Meeting

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Presented By Matt Galsky at 2018 ASCO Annual Meeting

L’importanza del Team multidisciplinare

Summary: Urothelial Carcinoma

Presented By Elizabeth Plimack at 2018 ASCO Annual Meeting

Quale scelta nella pratica clinica?

Next steps

Presented By Sandy Srinivas at 2018 ASCO Annual Meeting

Uno sguardo al futuro…

• La chemioterapia resta lo standard of care in prima linea nel paziente Fit e Unfit per CIS

• Necessità di biomarkers immunologici per ottimizzare utilizzo CPI in prima linea

• La targeted therapy rappresenta una valida alternativa nei pazienti con mutazione

• Occhio alle COMBO!!

TAKE HOME MESSAGE – Urothelial Cancer

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Presented By Andrea Apolo at 2018 ASCO Annual Meeting