A panel of experts on renal cell carcinoma (RCC) introduce themselves and discuss the first-line treatment landscape and risk stratification of clear cell RCC.

First-Line Treatments for Advanced Clear Cell RCC

Videos

A panel of medical oncologists who specialize in renal cell carcinoma (RCC) introduce themselves and discuss the first-line treatment landscape and risk stratification of clear cell RCC.

Chandler H. Park, MD, FACP, discusses the rationale for evaluating sacituzumab govitecan plus pembrolizumab in metastatic urothelial carcinoma.

Dr Park on the Rationale for the TROPHY-U-01 Trial in Urothelial Carcinoma

Chandler H. Park, MD, FACP, medical oncologist, Norton Healthcare, discusses the rationale for evaluating sacituzumab govitecan-hziy (Trodelvy) in combination with pembrolizumab (Keytruda) in cohort 3 of the phase 2 TROPHY-U-01 trial (NCT03547973) in patients with metastatic urothelial carcinoma who have progressed following platinum-based chemotherapy.

Bladder cancer presents a formidable treatment challenge due to its high levels of aggressiveness, particularly evident in stage IV cases where the 5-year overall survival rate is known to be less than 5%, Park begins. Although treatments such as pembrolizumab and platinum-based therapies are available for patients in this population, the efficacy of these regimens often falls short of what is desired, Park states. The TROPHY-U-01 trial focused on patients with stage IV metastatic urothelial cancer whose condition worsened after initial platinum-based chemotherapy, including those who experienced progression within 12 months of neoadjuvant chemotherapy, he explains. Notably, approximately 40% of patients had not responded to neoadjuvant chemotherapy within this time frame, Park adds.

Typically, patients receive immunotherapy following platinum-based chemotherapy in the metastatic setting, either pembrolizumab or the maintenance therapy approach from the phase 3 JAVELIN Bladder 100 (NCT02603432) study, which was avelumab (Bavencio), he continues. The TROPHY-U-01 study investigated whether combining sacituzumab govitecan, an antibody-drug conjugate, with pembrolizumab could enhance overall response rate (ORR) and duration of response (DOR), thereby improving clinical benefit rates (CBRs), Park elucidates. Patients, who were naive to checkpoint inhibitors, had experienced metastatic bladder cancer progression following platinum-based chemotherapy in the metastatic setting or within 12 months in the neoadjuvant setting, he notes.

The treatment of patients enrolled in the phase 3 study involved administering 10 mg/kg of sacituzumab govitecan on days 1 and 8, along with pembrolizumab on day 1 of each 21-day cycle, Park expands. The primary end point of the trial was ORR, and secondary end points included CBR, DOR, and progression-free survival as assessed by central review, he concludes.

Dr Park on the Use of Sacituzumab Govitecan Plus Pembrolizumab in Urothelial Carcinoma

Chandler H. Park, MD, FACP, medical oncologist, Norton Healthcare, discusses outcomes from cohort 3 of the phase 2 TROPHY-U-01 trial (NCT03547973) investigating sacituzumab govitecan-hziy (Trodelvy) in combination with pembrolizumab (Keytruda) in patients with metastatic urothelial carcinoma who have progressed following platinum-based chemotherapy.

The TROPHY-U-01 clinical trial is a multicohort, open-label investigation. Enrolled patients were checkpoint inhibitor–naive and displayed progression within 12 months post–platinum-based chemotherapy in the metastatic setting or neoadjuvant setting. Patients were treated with 10 mg/kg of sacituzumab govitecan once on days 1 and 8 of each 21-day cycle alongside 200 mg of pembrolizumab once on day 1 within each cycle. The primary end point evaluated was objective response rate (ORR) per central review. Secondary end points encompassed clinical benefit rate (CBR), duration of response (DOR), progression-free survival (PFS) per central review, and safety. 

Park begins by stating that regarding the combination of post-platinum chemotherapy and pembrolizumab, initial findings from single-agent pembrolizumab studies indicated response rates of approximately 20% to 21%. TROPHY-U-01 investigators examined whether the combination of an antibody-drug conjugate, such as sacituzumab govitecan, and pembrolizumab could enhance the response rates, prolong the DORs, and increase the CBRs seen with single-agent pembrolizumab in patients with metastatic urothelial cancer.

In terms of outcomes, cohort 3 comprised 41 patients with a median age of 67 years (range, 46-86), 83% of whom were male. At a median follow-up of 14.8 months (95% CI, 12.6-16.8), the ORR stood at 41% (95% CI, 26.3%-57.9%), with 20% of patients achieving a complete response, Park adds. Notably, the CBR was 46% (95% CI, 30.7%-62.6%), the median DOR was 11.1 months (95% CI, 4.8-not estimable [NE]), and the median PFS was 5.3 months (95% CI, 3.4-10.2).

Moreover, the median overall survival was 12.7 months (range, 10.7-NE), Park concludes. Grade 3 or greater treatment-related adverse effects were observed in 61% of patients, with the most prevalent being neutropenia (37%), leukopenia (20%), and diarrhea (20%).

Chandler H. Park, MD, FACP, discusses the use of sacituzumab govitecan plus pembrolizumab in patients with metastatic urothelial carcinoma.

Chandler Park, MD, MSc, FACP, co-director, Genitourinary Clinical Trials, Norton Cancer Institute, discusses the navigation and selection of later-line treatments for patients with metastatic urothelial carcinoma.

The number of available therapeutic options in bladder cancer has significantly expanded in recent years, Park begins. There is also a substantial amount of new data on the use of molecular testing and circulating tumor DNA for patients with stage II disease, he adds. However, precision medicine approaches are needed to navigate later-line treatment decisions for patients in the metastatic setting who have progressed on platinum-doublet chemotherapy in combination with avelumab (Bavencio), Park says. 

Tools like next-generation sequencing could be used to identify patients whose tumors harbor 

 alterations, Park explains. These patients may benefit from a targeted therapy such as erdafitinib (Balversa). 

Conversely, the antibody-drug conjugate (ADC) enfortumab vedotin-ejfv (Padcev) is an effective option for patients who do not harbor these mutations, Park continues. In April 2023, 

this agent was granted accelerated approval in combination with pembrolizumab (Keytruda)

 for patients with locally advanced or metastatic urothelial carcinoma who are cisplatin-ineligible based on data from cohort A and cohort K of the phase 1/2 EV-103/KEYNOTE-869 study (NCT03288545). 

 in the United States for patients with locally advanced or metastatic urothelial carcinoma who had previously received platinum-based chemotherapy and a PD-1 or PD-L1 inhibitor.

Additionally, other ADCs like sacituzumab govitecan-hziy (Trodelvy) my serve as an effective alternative to enfortumab vedotin for patients who have aggressive peripheral neuropathy, according to Park. This adverse effect is commonly observed in those receiving cisplatin and gemcitabine-based regimens, and is also seen in almost half of patients treated with enfortumab vedotin, Park adds. Accordingly, enfortumab vedotin is not an option for this population, he concludes.

Chandler Park, MD, MSc, FACP, discusses the navigation and selection of later-line treatments for patients with metastatic urothelial carcinoma.
 


Dr Park on Navigating of Later-line Treatment Options in Metastatic Urothelial Carcinoma

Chandler Park, MD, MSc, FACP, co-director, Genitourinary Clinical Trials at Norton Cancer Institute in Louisville, Kentucky discusses how the emerging field of radiotheranostics and increasing utilization of biomarker testing will improve the treatment of patients with metastatic hormone-sensitive prostate cancer (mHSPC).

Now that the efficacy of PARP inhibitors in 

-mutated metastatic castration-resistant prostate cancer (mCRPC) has been well established, current efforts aim to utilize these therapies in mHSPC, according to Park. Research in this space has demonstrated the heterogeneity of metastatic prostate adenocarcinomas, and the subsequent influence of germline and somatic mutations on treatment benefit and selection, Park explains.

Accordingly, all of these patients can benefit from somatic and germline genetic testing. Individuals with certain mutations should then be considered for clinical trials in the mHSPC space, Park adds. The presence of common mutations like 

 have become indicative of efficacy with current therapeutics; however, novel mutations such as 

 are increasingly included in biomarker screening, Park says.

The utilization of radiopharmaceuticals and molecular imaging is also increasing in prostate cancer, Park adds. The phase 3 VISION study (NCT03511664) contributed to this advancement by demonstrating the efficacy of the radioligand Lutetium 177 (

Lu-PSMA-617) as a third-line treatment for patients who progressed to mCRPC on a taxane and aromatase receptor (AR) inhibitor, Park says.

In December 2022, a press release also reported that the phase 3 PSMAfore trial (NCT04689828) of 

Lu-PSMA-617 met its primary end point of progression-free survival, Park adds. The trial was conducted in patients with mHSPC who had been previously treated with alternate AR-directed therapy before exposure to a taxane-containing regimen. Initial data from this trial will be released in 2023, he notes.

Other studies in the mCRPC space are investigating the use of 

Lu-PSMA-617 in combination with an AR inhibitor in earlier lines of therapy, Park adds. The agent is also being explored alongside other theragnostic radioligand treatments in mHSPC, Park concludes.

Chandler Park, MD, MSc, FACP, discusses how the emerging field of radiotheranostics and increasing utilization of biomarker testing will improve the treatment of patients with metastatic hormone-sensitive prostate cancer.

Chandler Park, MD, MSc, FACP

Articles

First-Line Treatments for Advanced Clear Cell RCC

Dr Park on the Rationale for the TROPHY-U-01 Trial in Urothelial Carcinoma

Dr Park on the Use of Sacituzumab Govitecan Plus Pembrolizumab in Urothelial Carcinoma

Dr Park on Navigating of Later-line Treatment Options in Metastatic Urothelial Carcinoma

Dr. Park on the Increasing Use of Biomarker Testing and Radiotheranostics in Prostate Cancer