Advertisement


Neal D. Shore, MD, on Prostate Cancer: Biomarker Analysis, Enzalutamide, and Active Surveillance

ESMO Congress 2022

Advertisement

Neal D. Shore, MD, of Carolina Urologic Research Center/Genesis Care, discusses new data from the ENACT trial, which showed that patients with prostate cancer and the RNA biomarkers PAM50 and AR-A were likely to have better outcomes with enzalutamide treatment. The results suggest that such RNA biomarkers may help to identify patients who may benefit from enzalutamide treatment compared with active surveillance (Abstract 1385P).



Transcript

Disclaimer: This video transcript has not been proofread or edited and may contain errors.
We published our results from the ENACT trial just a couple of months ago in JAMA Oncology. It was an interesting trial design. It was phase two, a little over 230 patients, one to one randomization; grade group one enriched and grade group two patients. Half the patients we continue to monitor in traditional active surveillance and the other half of the patients received full dose enzalutamide, the oncolytic dose for advanced prostate cancer patients. Our primary endpoints included progression, therapeutic progression based upon moving to active intervention treatments and PSA elevations. And then we also had biopsy key data at one year and two year. The patients received in the treatment arm, open label therapy with enzalutamide for one year. What we saw was a marked decrease in positive biopsy rates and a benefit to staying on treatment, on active surveillance when taking administering enzalutamide. More patients, in other words, who did not take the enzalutamide went on to active treatments. Now I want to be perfectly clear because of some of the reaction and comments I saw from my colleagues that robust education on active surveillance is really important. But what we know is that many physicians and many patients have a difficult time staying the course of active surveillance. They go to treatment, surgery, radiation, focal therapies for a whole sundry of reasons, including PSA kinetics and concern about not doing something actively when there's cancer present. Our biomarker study looking at PAM50, luminal and basal components, as well as antigen receptor activation, as well as the Decipher score has now clearly demonstrated that we can have a prognostic benefit for patients who had high Decipher scores to know that they would go on to therapeutic progression, which was the endpoint of the ENACT trial and looking at AR amplification as well as the PAM50 luminal basal delineations, we can see, and our first author, Ashley Ross, senior author, Ted Schaeffer have clearly demonstrated that these RNA biomarkers are very informative. So as we move towards more understanding of who would be a better candidate for active surveillance versus taking a treatment, I think these will be very helpful. I look forward to additional trials where we may dose adjust with the AR blocker. We may find different ways to administer the AR blocker, perhaps intraprostatic injection or perhaps different dosing, different dose scheduling. The bottom line I think, this RNA biomarker analysis is helping us to further inform physicians and patients regarding personalized decision making and fidelity to an active surveillance protocol and avoiding active treatments that may be more morbid and more costly.

Related Videos

Kidney Cancer
Immunotherapy

Axel Bex, MD, PhD, on Renal Cell Carcinoma: Phase III Results With Atezolizumab as Adjuvant Therapy

Axel Bex, MD, PhD, of the Netherlands Cancer Institute, discusses phase III findings from the IMmotion010 study, which evaluated the efficacy and safety of atezolizumab vs placebo in patients with renal cell cancer who are at high risk of disease recurrence following nephrectomy (Abstract LBA66).

Skin Cancer
Immunotherapy

Georgina V. Long, MD, PhD, on Melanoma: Findings on Circulating Tumor DNA, Disease Recurrence, and Immunotherapy

Georgina V. Long, MD, PhD, of the Melanoma Institute Australia, discusses results from the CheckMate 915 trial, an analysis of the pretreatment circulating tumor DNA, along with other clinical and translational baseline factors, and their association with disease recurrence in patients with stage IIIB–D/IV melanoma treated with adjuvant immunotherapy (Abstract 788O).

Solid Tumors

Bernd Kasper, MD, PhD, on Desmoid Tumors: Results on Nirogacestat vs Placebo

Bernd Kasper, MD, PhD, of Germany’s Mannheim Cancer Center, discusses phase III data from the DeFi trial, the largest study conducted to date for patients with desmoid tumors. The trial showed that the gamma secretase inhibitor nirogacestat demonstrated improvements in all primary and secondary efficacy endpoints. Although considered benign because of their inability to metastasize, desmoid tumors can cause significant morbidity and, occasionally, mortality in patients (Abstract LBA2).

Skin Cancer
Immunotherapy

Sapna P. Patel, MD, on Melanoma: New Data on Pembrolizumab, Adjuvant vs Neoadjuvant Plus Adjuvant

Sapna P. Patel, MD, of The University of Texas MD Anderson Cancer Center, discusses the latest findings from the SWOG S1801 trial, which showed that using single-agent pembrolizumab as neoadjuvant therapy improved event-free survival compared to adjuvant therapy in high-risk resectable stage III–IV melanoma (Abstract LBA6).

Lung Cancer

Charles Swanton, PhD, on Non–Small Cell Lung Cancer Induced by Air Pollution

Charles Swanton, PhD, of The Francis Crick Institute, discusses a newly discovered mechanism of action for air pollution–induced non–small cell lung cancer in which particles linked to climate change appear to promote cancerous changes. The finding might pave the way for new potential approaches to lung cancer prevention and treatment (Abstract LBA1).

Advertisement

Advertisement



Advertisement