Dr. Massard emphasised the change in clinical trials networks/units, and the addition of a network for rare and common cancers (i.e. in particular, rare molecular alterations). He added that bolstering education and fellowship involves training and empowering young fellows.

Penile preservation

In the following presentation “Strategies for penile preservation in early penile cancer”, urologist Dr. Arie Parnham (GB) stated that glans resurfacing is a good option for low-risk T1 tumours and glansectomy is a favourable option for T1-T2 tumours.

According to Dr. Parnham, brachytherapy is an alternative treatment but with a caveat. He advised, “One needs to gain enough experience to administer it.” Furthermore, organ-sparing is not always the optimal choice. He underscored that discussion of the oncological implications of recurrence is imperative, especially in a high-risk disease. “The data has shown, for example with grade-3 disease or if there’s a chance of a high recurrence rate, a radical treatment option may be the way to go.”

Dr. Parnham has stated that at present, data on how treatment affects functional and quality-of-life outcomes is scarce.

New interventions

On behalf of medical oncologist Dr. Yohann Loriot (FR), Dr. Massard presented the lecture “Novel immune approaches in GU”.

New immune biotechnologies
Several new technologies have been developed such as chimeric antigen receptor [CAR] T cells and bispecific T cell engagers. He listed the five main challenges with CAR-T cells: Cytokine release syndrome; immune effector cell-associated syndrome; manufacturing of drugs; necessitation of chemotherapy preconditioning; and costs.

T cell engagers (TCE) were also discussed and defined as therapeutic proteins that can connect a T cell with a tumour cell. Most TCE have three domains: a domain that binds to a component of the T-cell receptor; a domain that binds to a tumour-associated antigen; and a domain that provides additional functionality such as half-life-extension.

Personalised mRNA vaccines were mentioned as well which involved a resection; the processing and transport of tissues; and the definition of the tumour and normal DNA sequence. Afterward, the neoantigens are predicted and selected. Finally, an autogene cevumeran (individualised neoantigen-encoding mRNA-lipoplex) is custom-manufactured.

New combinations

Antibody-drug conjugates (ADCs) are used for targeted chemotherapy. ADCs have high effective Intratumoural drug concentration, efficiency in cancer-cell killing, and lower systemic distribution and off-target effects.

In addition, new combinations are currently being tested (PD1 + LAG3 inhibitors).

New strategies
Immunotherapy (IO) might be more active in the early stages, and biomarkers might be helpful in developing IO.

Medical oncologist Dr. Elena Castro (ES), radiotherapist Prof. Valerie Fonteyne (BE), and urologist Prof. Morgan Rouprêt (FR) moderated the session.

Watch the full presentations and view the session recap from the EMUC23 Resource Centre.

The post New opportunities in GU cancers appeared first on EMUC25.

Oncologist Prof. Ananya Choudhury (GB) began her presentation on radioimmunotherapy for bladder preservation stating, “Surgery is not the only gold standard for treating localised muscle-invasive bladder cancer. There is plenty of data out there. Whether you look at match cohorts from a single institution, epidemiologically at population data or meta-analysis of the published studies, they show that bladder preservation has equivalent outcomes to radical cystectomy.”

During her lecture, Prof. Choudhury also cited high-level data from an individual patient data meta-analysis which shows that hypofractionation of giving radiotherapy over four weeks 55Gy/20f is superior to 64Gy/32f for invasive loco‐regional control (ILRC). She stated, “55Gy/20f should form the standard of care for any combination protocols going forward.”

She concluded her lecture with this statement: “I think we do not know what optimal radiotherapy dose and fractionation to combine with immunotherapy. I am hesitant about whether we should combine at all. We do not know what is the optimal radiosensitiser to combine alongside radiotherapy with immunotherapy. Are we suggesting that we should compromise on the radiotherapy schedule so that we can test immunotherapy safely? I am uncertain that it is something I am prepared to do. What we do know is there are numerous trials which are ongoing. There is going more data for us to discuss and on how best to treat our patients.”

In “The role of surgery in the era of immunotherapy” Prof. Arnulf Stenzl (DE) said, “We think about surgery as being cytoreductive; it can be informative or supportive for immunotherapy. The role of surgery is to obtain tissue information. It is a multimodal concept. The sequence that opens the window for opportunity is so important e.g. the combination strategies of surgery and immunotherapy wherein immunosuppressive effect is turned into a therapeutic opportunity.”

Watch their presentations in full, along with other highly-informative lectures of the session. Access the Resource Centre for more EMUC21 content.

The post Plenary Session 7 tackles radioimmunotherapy and surgery’s role in immunotherapy era appeared first on EMUC25.

She stated that overall survival (OS) benefit with Nivolumab + Ipilimumab is the new benchmark, and pointed out that some good-risk patients can achieve complete response (CR) with IO approach. She added that given OS benefit in some of the IO-based combination is “practice changing”.

Dr. Albiges stated that to date, clinical strategy uses clinical risk classifications; but there is “much more to do to increase patient selection”.

“This debate is not about immunotherapy per se but about the timing of immunotherapy. It does not necessarily need to be the first-line treatment in all patients,” said Prof. Manuela Schmidinger (AT).

She stated that favourable-risk and some intermediate-risk patients may be better off with delayed immune-checkpoint inhibitors (ICI) as using ICI combinations too early in the course of the disease could signify a loss of opportunity.

Prof. Schmidinger said, “The worst-case scenario is if your patient does not benefit from important drugs because you simply did not use them in the right setting and at the right time,” as she referred to patients who are immunologically prepared for the drugs.

“Outcomes of targeted agents (TA) + ICI studies are somewhat disappointing, considering that this is the ‘best’ strategy ever,” stated Prof. Schmidinger. “The timing is probably wrong.” She added that the likelihood that patients would receive ICI a second time is low.

According to Prof. Schmidinger, “ICI should be used when the tumour is up to it, when the tumour is hot. Let’s make sure it’s hot beforehand.”

Plenary Session 04 was chaired by Dr. Maurizio Colecchia  (IT), Prof. Dr. Igle Jan De Jong  (NL),  Prof. S. Silke Gillessen Sommer (CH), Dr. Ananya Choudhury (GB) and Dr. Ashish Kamat (US).

For more information and to access webcasts and abstracts, check out the EMUC18 Resource Centre.

The post Deliberations on IO as first-line therapy for kidney cancer patients appeared first on EMUC25.