The bulk of this month’s articles come from the 2015 European Cancer Congress in Vienna, Austria. We lead off with positive news in bladder cancer regarding atezolizumab as second-line therapy in patients with metastatic urothelial carcinoma (mUC) who had a poor prognosis after progressing following platinum-based chemotherapy. Results from IMvigor 210 demonstrated significant overall response rate (ORR) improvements across all groups with higher PD-L1 expression. ORR by RECIST 1.1 was 15% (

 = .0058) in all comers, 18% (P = .0004) at the IC1/2/3 level (any PD-L1 expression), and 27% (

 = .0001) in the IC2/3 subgroup with PD-L1 expression ≥5%.

This is welcome news because currently available treatments in metastatic urothelial cancer are “dismal,” according to the lead investigator, Jonathan Rosenberg, MD, a medical oncologist at Memorial Sloan Kettering Cancer Center. The agent has the potential to change the standard of care in metastatic urothelial carcinoma.

In renal cancer news, we report on the phase III METEOR study, which compared second-line treatment of cabozantinib (Cometriq) with everolimus in patients with advanced kidney cancer who have received prior standard therapy that targets the vascular endothelial growth factor receptor. Investigators noted a significant reduction in the rate of disease progression or death in the cabozantinib arm as compared with the everolimus arm.

It was not all positive news in RCC, however. The IMA901 multipeptide vaccine failed to improve outcomes when added to sunitinib as first-line therapy for advanced/metastatic in RCC. The open-label phase III trial compared the multipeptide vaccine in combination with sunitinib with sunitinib alone, which is standard first-line therapy and is thought to have immune-boosting properties. “There was no overall survival advantage to the investigational arm of the vaccine. In fact, the hazard ratio favored the control arm of the trial,” said lead author Brian Rini, MD, associate professor of medicine, the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University.

In prostate cancer, results from the tasquinimod trial were not encouraging. Though initially promising in phase II trials, the agent failed to improve overall survival in a phase III trial in men with treatment-naïve metastatic castration-resistant prostate cancer. The manufacturers, Active Biotech and Ipsen, have discontinued development. Finally, an updated analysis of the STAMPEDE trial upholds the survival benefit observed with early use of docetaxel in advanced prostate cancer, but does not support the introduction of zoledronic acid.

Other feature articles included in this month’s issue focus on the benefits of a multidisciplinary care approach when radium-223 is added to the treatment regimen in advanced prostate cancer. The Genitourinary Multidisciplinary Clinic, a program of The Comprehensive Cancer Center at The Miriam and Rhode Island hospitals and which opened in 2007, incorporates 4 medical disciplines: medical oncology, radiation oncology, urologic oncology, and nuclear medicine physicians, with support from other services to enhance the patient experience and operational efficiency. Joseph F. Renzulli II, MD, and colleagues described an efficient and cost-effective workflow through their clinic that relies on the collaboration between many specialists.

This month’s Practice Profile column highlights the work of the Urologic Cancer Center (UCC) provided by Urology Centers of Alabama. Before the UCC opened, president Mark DeGuenther, MD, said that they found the urologists were categorized into 3 camps: those who had a keen interest in treating patients with advanced prostate cancer with emerging therapies, those who had a passing interest, and those who had no interest. The column describes how patient care was optimally provided.

Articles


	
	
		OncLive Chairman,
		Mike Hennessy


Mixed Study Results in GU Tumor Types Reported From 2015 ECC

The IMA901 multipeptide vaccine added to sunitinib failed to improve outcomes versus sunitinib alone as first-line therapy for advanced/metastatic renal cell carcinoma (RCC). These disappointing results, presented at the 2015 European Cancer Congress, point out the difficulties in developing therapeutic vaccine and illuminate areas where refinements are needed if a vaccine is to be effective in RCC.

“There was no improvement in overall survival when adding IMA901 to first-line sunitinib in patients with advanced renal cell cancer. Survival was comparable in both arms in favorable risk patients. Longer overall survival was observed in intermediate-risk patients with sunitinib alone. Methods to improve immune responses would need to be identified before further development of IMA901 in metastatic renal cell carcinoma is indicated,” said lead author Brian Rini, MD, associate professor of Medicine, the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University.

The open-label phase III trial compared the multipeptide vaccine in combination with sunitinib with sunitinib alone, which is standard first-line therapy and is thought to have immune-boosting properties.

“Favorable reductions in regulatory T cells suggest that sunitinib modulates the tumor microenvironment and assists in the immune response,” he said.

Phase II results with the vaccine alone plus or minus cyclophosphamide showed an association between magnitude of T-cell responses and survival, Rini explained. Patients given cyclophosphamide had a better immune response.

The phase III open-label trial enrolled 339 patients with metastatic RCC who were HLA-A*02 positive and had favorable or intermediate risk status. Following 1 cycle of sunitinib, patients were randomized 3:2 to up to 10 intradermal vaccinations of IMA901 plus 75 μg GM-CSF plus sunitinib (50 mg; standard 4 weeks on/2 weeks off) versus sunitinib alone. Patients in the vaccine arm were given a single infusion of cyclophosphamide 3 days before the first vaccination to reduce regulatory T cells.

For the primary endpoint of overall survival (OS), 204 patients in the vaccine arm and 135 in the sunitinib arm were evaluable.

“There was no overall survival advantage to the investigational arm of the vaccine. In fact, the hazard ratio favored the control arm of the trial,” Rini stated.

Median OS was 33.1 months in the vaccine arm versus not reached in the control arm, which was not statistically significant.

When analyzed according to risk status, the survival curves for the two arms overlapped in favorable-risk patients and favored the control arm for intermediate risk patients (27. 8 weeks for the vaccine versus not reached for the control arm, 

Progression-free survival (PFS) was longer than expected in both arms and not significantly different—about 15 months according to central review. By contrast, investigator analysis showed longer PFS in intermediate-risk patients treated with sunitinib alone: 15.1 months in the vaccine arm versus 17.9 months in the control arm, which led to higher exposure to sunitinib in the control arm.

The vaccine had a favorable safety profile, with similar rates of adverse events in both arms. Transient injection-site reactions were the most frequent vaccine-related adverse events.

Immune data showed that sunitinib led to a significant decrease in monocytes after the first injection. There was no clear or significant association between T-cell responses and clinical outcome, including survival.

“The effect of sunitinib could have negatively affected the vaccine response, but this is a hypothesis. The magnitude of response to IMA901 in this trial is less compared with other studies of the vaccine in different tumor types,” said Rini.

“With tumor vaccines, there is a huge difference between our goals and what actually happens. Many trials of tumor vaccines fail. Many steps are involved in developing therapeutic vaccines,” said Ignacio Melero, MD, who discussed this trial at the meeting.

He commended the investigators of the study and said that the vaccine was “smartly developed.”

“The phase II results were enticing, showing a survival difference in renal cell carcinoma in patients premedicated with cyclophosphamide who developed immune responses. The phase III trial is well conducted, but the trial is basically negative with no difference in survival. In my opinion, this is may be related to prolonged exposure to sunitinib,” he continued.

“The data from phase II were not replicated. Those patients who mounted an immune response did not do better,” he emphasized.

Melero, professor of immunology at the University of Navarra, Pamplona, Spain, suggested the following possible ways to improve vaccine development for RCC: longer peptides; neoantigens; no sunitinib; combination with checkpoint inhibitors; rethink the biology of immune response induction.

	Rini B, Stenzl A, Zdrojowy R, et al. Results from an open-label, randomized, controlled phase 3 study investigating IMA901 multipeptide cancer vaccine in patients receiving sunitinib as first-line therapy for advanced/metastatic RCC. Presented at: 2015 European Cancer Congress; September 25-29; Vienna, Austria. Abstract LBA 17.

The IMA901 multipeptide vaccine added to sunitinib failed to improve outcomes versus sunitinib alone as first-line therapy for advanced/metastatic renal cell carcinoma.

Renal Cell Carcinoma Vaccine Fails to Improve Outcomes

Patients with renal cell carcinoma have better outcomes when undergoing nephron-sparing surgery rather than radical nephrectomy, according to findings from national Surveillance, Epidemiology, and End Results (SEER) registry (2001-2009) data. William C. Huang, MD, of the New York University Langone Medical Center and colleagues noted that overall survival was better in patients who received surgical treatment than in those who received nonsurgical management. However, only nephron-sparing surgery was associated with a benefit in cancer-specific survival (adjusted hazard ratio, 0.47; 95% CI, 0.31-0.69; 

Surgery continues to be the most common treatment in the management of small kidney cancers, with nephron-sparing surgery exceeding radical nephrectomy. The researchers noted that in elderly patients or those with limited life expectancy, nonsurgical management is a reasonable treatment strategy. Huang said in a release that “although our findings support nonsurgical management as an acceptable treatment option for small kidney tumors in elderly patients or those with limited life expectancy, it appears that nonsurgical management of small kidney cancers remains uncommon and stable over time.” He added that heightened awareness of outcomes from studies such as this may increase the use of nonsurgical management.

In the population-based cohort study, SEER cancer registry data linked to Medicare claims were used to identify patients 66 years or older with a diagnosis of primary renal-cortical tumor (<4 cm). Analysis was performed between February 1, 2014, and December 31, 2014. The likelihood of receiving no surgery versus surgical intervention was analyzed as a function of demographic and disease characteristics, as well as the relationships between treatment approach and overall and cancer-specific survival.

According to their findings, published in 

, radical nephrectomy is no longer the treatment of choice for small kidney cancers. “Expert guidelines for the management of small renal masses, such as those published by the American Urological Association in 2009, appear to have bolstered the paradigm shift away from radical nephrectomy toward nephron-sparing options for such tumors,” said Huang.

The same practice guidelines also offer ablation and surveillance as alternative treatment options for small kidney masses, noted Huang. Partial nephrectomy and ablation were combined and classified as nephron-sparing surgery and nonsurgical management was defined as the absence of any claim for one of these procedures in the first 6 months following diagnosis. During the study period, 3709 of the patients (61.9%) who underwent surgery had radical nephrectomy, and 2285 patients (38.1%) had a nephron-sparing procedure.

Out of a total of 6664 patients, 90.0% (5994) underwent surgery; 10% (670) of patients were managed nonsurgically. The data revealed that the use of radical nephrectomy decreased from 69% to 42.5%. During the same time, nephron-sparing surgery (partial nephrectomy and ablation) increased from 21.5% to 49.0%. The proportion of patients who chose not to undergo surgery remained stable, reported the investigators. During a median follow-up of 63 months (interquartile range, 43-89 months), 2119 patients (31.8%) died, including 293 (4.4%) from kidney cancer.

“Our findings underscore the importance of competing causes of mortality in this population: 38.1% of patients died during the study period, but only 4.4% of patients died from kidney cancer,” said Huang.

	Differences in overall survival may reflect patient selection rather than a direct benefit of surgery, as highlighted by the greater risk of mortality observed soon after diagnosis in the cohort managed non-surgically, he said.

	“Survival outcomes of partial nephrectomy appear to be at least equivalent and potentially superior in the short-term (median, 63 months) compared with radical nephrectomy,” according to Huang. “Practically, the support for partial nephrectomy is bolstered both by patients hoping to preserve as much kidney as possible to prevent the burdens of hemodialysis and the urologist who has benefited from improvements in surgical experience.”

	With controls for demographic and disease characteristics as well as comorbid conditions, patients whose care was managed non-surgically were more likely to be older, male, and nonwhite and to reside in the Western United States. Hypertension was associated with a greater likelihood of being treated surgically, and a prior non-kidney cancer diagnosis was associated with a greater likelihood of nonsurgical management, said Huang.

	With a median follow-up of 57 months (inter-quartile range, 43-89 months), 136 patients (20.3%) who initially received nonsurgical treatment underwent surgery more than 6 months after diagnosis.

	In an accompanying editorial titled, Joshua J. Meeks, MD, PhD, department of urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, said that “the authors establish partial nephrectomy as the new standard of treatment for small renal masses (SRMs) with the frequency of nephron-sparing surgery eclipsing that of radical nephrectomy in 2009.”

	Meeks noted that despite an overall increase in surgery for SRMs, the survival for patients with kidney cancer has not changed. In this study, a consistent 10.0% of tumors were actively monitored and these tumors were more likely to occur, he said.

	“In older and unhealthy patients with overall survival of only 57.5% at the completion of the study, it is unclear how many masses were identified by imaging but not biopsied and therefore potentially not identified by the SEER registry,” said Meeks.

	“At some point,” he emphasized, “every metastatic cancer must have been an SRM. As we learn more about the molecular signature of renal cancer and the mutations that drive progression, we will likely be managing SRMs differently in the near future.”

Patients with renal cell carcinoma have better outcomes when undergoing nephron-sparing surgery rather than radical nephrectomy.

In Kidney Cancer, Better Outcomes Demonstrated With Nephron-sparing Surgery

Tasquinimod, a drug that showed great promise in phase II trials, failed to improve overall survival (OS) in a phase III trial in men with treatment-naïve metastatic castration-resistant prostate cancer (mCRPC).

Based on the results, Active Biotech and Ipsen have discontinued development of this novel agent in prostate cancer.

“In the phase III trial, although radiographic progression-free survival [rPFS] was longer with tasquinimod—similar to the phase II results&mdash;this did not translate to an overall survival effect. In fact, survival favored placebo,” said lead investigator Michael Carducci, MD, Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center.

“We don’t know the reasons for the disconnect between the radiographic progression-free survival benefit and lack of a survival benefit,” he told attendees at the 2015 European Cancer Congress.

Tasquinimod is an oral therapy that is thought to target the tumor microenvironment. The drug is reported to elicit an immune response, antiangiogenic activity, and antimetastatic activity, but formal discussant of this abstract, Johann De Bono, MD, took issue with the purported mechanism of action “We don’t really know how this drug works, and that should cause concern,” said De Bono.

Carducci explained that in the phase II randomized, double-blind, placebo-controlled trial in a similar patient population, tasquinimod significantly extended radiographic progression-free survival (rPFS) versus placebo: median rPFS was 3.3 months with tasquinimod versus 7.6 weeks with placebo (

“The greatest benefit of tasquinimod in the phase II trial was in patients with bone-only metastasis, with a median rPFS of 12.1 months versus 5.4 months for placebo,” he said.

The randomized, double-blind, placebo-controlled, phase III study screened 1645 men and enrolled 1245 men with asymptomatic or mildly symptomatic, chemotherapy-naïve mCRPC with metastasis confined to the bone. Subjects were randomized in a 1:1 ratio to receive tasquinimod once a day titrated to a dose of 1 mg/day over 4 weeks or placebo and treated until the occurrence of disease progression or unacceptable toxicity.

The study met the primary endpoint, with a significant benefit for tasquinimod in rPFS: 7 months versus 4.4 months for placebo (

 <.001). Subgroup analysis showed a benefit across the board for tasquinimod in rPFS.

However, no survival advantage was observed. Median OS was 21.3 months for tasquinimod versus 24 months for placebo, and no significant trends toward benefit for tasquinimod were observed in any subgroup.

More patients assigned to tasquinimod stopped treatment due to adverse events. There were more reports of decreased appetite, nausea, fatigue, and asthenia in the tasquinimod arm, which may have led to higher rates of discontinuation of study drug, Carducci said.

In his discussion, De Bono assured attendees that studying failed trials can lead to success by learning lessons about disease biology, drug pharmacology, and how to design better trials.

First, as mentioned above, he took issue with the mechanism of action of tasquinimod, noting that it is poorly understood.

“However, that shouldn’t stop going to phase III trials if the drug has significant antitumor activity,” commented De Bono.

After reviewing the phase I and II tasquinimod data, he found that the antitumor activity of the drug was “modest at best.”

“It would be more important to analyze the genome of those who were exceptional responders to understand why the drug worked in them,” he said.

The disconnect between phase II rPFS and OS in phase III has been seen before in prostate cancer with other drugs, so it shouldn’t have been a surprise, he continued.

His main argument was that rPFS is not a good surrogate marker for OS in mCRPC. “Results of this trial and other trials show that rPFS is truly not an intermediate endpoint in prostate cancer,” he stated. At best there is a poor correlation between rPFS and OS in MCRPC.”

“Randomized phase II results are overrated in prostate cancer. These trials are misleading us, with a high rate of false positivity. We need to raise the bar in clinical trials,” De Bono emphasized.

According to De Bono, the way forward is to understand the genome of prostate cancer patients and target actionable mutations. Also, better surrogate endpoints are needed to accelerate anticancer drug development.

“We need better understanding of mCRPC to advance our success in finding effective treatments for this disease,” he concluded.

			Carducci M, Armstrong A, Pili R, et al. A phase 3, randomized, double-blind, placebo-controlled study of tasquinimod (TASQ) in men with metastatic castrate resistant prostate cancer (mCRPC). Presented at: 2015 European Cancer Congress; September 25-29; Vienna, Austria. Abstract 4BA.

			Pili R, Häggman M, Stadler WM, et al. Phase II randomized, double-blind, placebo-controlled study of tasquinimod in men with minimally symptomatic metastatic castrate-resistant prostate cancer.

Tasquinimod, a drug that showed great promise in phase II trials, failed to improve overall survival in a phase III trial in men with treatment-naÃ¯ve metastatic castration-resistant prostate cancer.

Tasquinimod Discontinuation in mCRPC Discussed at 2015 ECC 

Patients who participated in a multidisciplinary care clinic experienced improved outcomes, especially when radium-223 was integrated into an overall treatment program. This is good news because while the advances in molecular oncology and targeted therapies have revolutionized treatment of many solid tumors and hematologic malignancies, improvements in treatment options for men with metastatic castration resistant prostate cancer (mCRPC) have been slower to develop.

However, since 2010 urologists and oncologists have embraced the development of Sipuleucel-T immunotherapy, cabazitaxel chemotherapy, the oral agents abiraterone and enzalutamide, and recently, Radium-223. All of the above agents confer an overall survival advantage in metastatic prostate cancer. However, with these advancements comes questions and controversy regarding optimal treatment sequencing, combination therapy, and appropriate patient selection.

Joseph F. Renzulli II, MD, and researchers, recently described an efficient and cost-effective workflow through a multidisciplinary care (MDC) clinic that relies on the collaboration between urologists, medical oncologists, radiation oncologists, nuclear medicine physicians and ancillary caregivers.

The model is particularly successful when radium-223 is incorporated into the patient’s treatment regimen. Their findings are published in the 

	The Genitourinary Multidisciplinary Clinic

“Our goal was to demonstrate that radium 223 is an ideal drug to incorporate into the treatment algorithm for mCRPC through a multidisciplinary collaborative effort. We believe more timely and effective utilization or radium 223 results from a multidisciplinary approach. It is the team approach that is important. There is no one specialty that is able to administer radium-223 given that it requires referral to a radiation oncologist or nuclear medicine physician, and that referral typically originates from a urologist or oncologist,” said Renzulli, an assistant professor at the Warren Albert Medical School at Brown University.

The Genitourinary Multidisciplinary Clinic, opened in 2007, it incorporates 4 medical disciplines: medical oncology, radiation oncology, urologic oncology, and nuclear medicine physicians, with support from other services to enhance the patient experience and operational efficiency. Psychiatric services are provided for newly diagnosed patients, a licensed nutritionist is available for men receiving hormonal deprivation therapy, a nurse navigator assists in the treatment management process, and a nurse practitioner assists in patient management. The clinic also provides patients to access to a social worker as needed. Patients can be referred to the MDC through a urologist, a primary care physician following a new diagnosis of prostate cancer or for a second opinion. Prior to a new patient visit all outside pathology is reviewed by a dedicated genitourinary pathologist. The initial patient consultation includes reviews of radiologic films and pathology reports with the patient and family members, and an initial treatment plan is developed. The patient receives counseling about quality of life issues, treatment expectations, and patient goals to formulate the best individual treatment plan.

Traditionally, radiation oncologists and nuclear medicine physicians rarely encounter a patient with mCRPC, unless referred by a urologist or a medical oncologist. The MDC setting allows these specialists to provide clinical input into the management plan, especially in light of the potential use of radium-223. Radium-223 is a new treatment that, unlike earlier radionuclide therapies, has shown an overall survival advantage in a large randomized phase 3 trial (ALSYMPCA). In the ALSYMPCA study, patients receiving radium-223 had a significantly prolonged time to onset of their first symptomatic skeletal event (median, 15.6 months vs 9.8 months; hazard ratio =0.66; 95% CI, 0.52—0.83; 

 <0.001) compared with those who received placebo. This treatment benefit and increased overall survival occurred independent of prior docetaxel therapy or concomitant bisphosphonate therapy.

Radium-223 is approved for treatment of patients with CRPC with symptomatic bone metastases and no known visceral metastases. The recommended dosing regimen is six cycles of 50 kBq/kg radium-223 therapy 4 weeks apart. As a calcium mimetic, radium-223 binds to hydroxyapatite at sites of osteogenesis associated with metastatic prostate cancer.

		Figure. Flow of patients with mCRPC treated at The Miriam Hospital MDC

		Abbreviations: mCRPC, metastatic castration-resistant prostate cancer; MDC, multidsciplinary clinic; GU, genitourinary; RN, registered Nurse

Radium-223 decays through emission of four high-energy alpha particles over an ultra-short distance, resulting in predominantly irreparable double-stranded DNA breaks in nearby cells that lead to cell death. The short range of alpha particles ensures that nearby cells (tumor) are affected to a greater extent than more distant (normal) tissues.

“What distinguishes radium-223 from sumarium- 153 and strontium-89 is that the others are utilized solely for palliation. It is important to distinguish an alpha emitter which offers an overall survival advantage from the other available treatments,” said Renzulli.

There is significant heterogeneity in castration resistant prostate cancer. “We know by the AR-V7 mutation that there are some prostate cancers that may be resistant to the available oral therapies. We know that these individuals may respond better to upfront cytotoxic therapy with docetaxel,” said Renzulli.

“In terms of sequencing, the one thing that we have started to do is avoid using oral therapies sequentially. If a patient is on an oral therapy, such as Zytiga/prednisone and they start to demonstrate failure, we then use chemotherapy or radium 223. If they have an encouraging response we may then return to an oral therapy such as Xtandi, but we are definitely not using them back to back because of the cross resistance that we have seen.”

In the MDC, patients usually receive radium-223 therapy rather early in the course of their metastatic disease, when the disease burden is low with few bone metastases and no visceral metastases. Radium-223 therapy may be most effective at this point for prolonging survival and achieving the best outcome. Earlier use in patients with low tumor volume has the potential advantage of reducing disease burden, thus allowing more opportunity to sequence subsequent therapies during the patient’s treatment course.

Urologists do not receive training in administering chemotherapy, however with recent advancements, it is important that urologists be comfortable caring for prostate cancer patients concurrently receiving chemotherapy. “The CHAARTED and STAMPEDE trials have now brought chemotherapy to the frontline with respect to hormone sensitive metastatic prostate cancer” said Renzulli. “Urologists have to continue to coordinate care, in a multidisciplinary fashion, with radiation oncologist and medical oncologist to assure their patients are receiving cutting edge care. I think that’s of paramount importance in metastatic prostate cancer.”

For solo practitioners, there is still a role for multidisciplinary care, said Renzulli. “The solo practitioner can team up with a medical oncologist, radiation oncologist and/or nuclear medicine physician and create a protocol for patients who are candidates for radium 223 and decide how they are going to manage the patient.” He said this doesn’t require the development of a “true” multidisciplinary center, but rather should incorporate “a collaborative effort where the physicians have an arrangement where patients will have access to multiple healthcare specialist caring for the patient with mCRCP.”

Though many clinicians believe that providing care in an MDC is inefficient and costly to their overall practice, overall survival rates for patients with advanced prostate cancer have been superior when treatment is delivered through a MDC. The researchers wrote that the “multidisciplinary approach fosters improved surgical outcomes with decreased surgical complications, resulting from increased surgeon experience and surgical volume, enhanced radiation oncology options, increased participation in clinical trials and high patient satisfaction.”

It may also enhance the confidence of referring physicians that patients are receiving optimal therapy and may reinforce the decision to refer patients, rather than to continue managing them alone. The approach reduces the likelihood that patients will be viewed as typical and treated with a standard regimen when their disease characteristics indicate an alternate approach, or in a changing treatment environment where former standards are no longer recognized as optimal.

“Radium-223 provides an overall survival advantage and reduces symptomatic skeletal related events. It mandates coordination of care between at least two disciplines, a urologist or medical oncologist with a radiation oncologist or nuclear medicine physician. This collaborative effort is critical to ensure the patient has the opportunity to complete the 6 cycles of therapy,” concluded Renzulli.

	1. Renzulli JF 2nd, Collins J, Mega A. Radium-223 dichloride: illustrating the benefits of a multidisciplinary approach for patients with metastatic castration-resistant prostate cancer. 

With the advancement of radium-223 comes questions and controversy regarding optimal treatment sequencing, combination therapy, and appropriate patient selection.

October 2015 | Oncology Live Urologists in Cancer Care®

Mixed Study Results in GU Tumor Types Reported From 2015 ECC

Renal Cell Carcinoma Vaccine Fails to Improve Outcomes

In Kidney Cancer, Better Outcomes Demonstrated With Nephron-sparing Surgery

Tasquinimod Discontinuation in mCRPC Discussed at 2015 ECC

One Clinic's Multidisciplinary Approach Optimizes the Use of Radium-223