Renal & Urology News Sept-Oct 2017 issue

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SE P T E MBE R /O C T O BE R 2017

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VO L UME 16, IS SUE NUMBE R 5

Front-line mRCC Therapy to Shift Checkpoint inhibitors found superior to sunitinib

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www.renalandurologynews.com

IMMUNOTHERAPY VS SUNITINIB In the Checkmate-214 trial of patients with previously untreated metastatic renal cell carcinoma, those who received a checkpoint inhibitor combination of nivolumab and ipilimumab had a better objective response rate (ORR) and longer median progression-free survival (PFS) than those who received sunitinib. Nivolumab/ipilimumab

Sunitinib

41.6%

BY JODY A. CHARNOW CLINICAL TRIAL findings presented at European Society for Medical Oncology (ESMO) 2017 Congress in Madrid, Spain, could signal a major shift in the front-line treatment of metastatic renal cell carcinoma (mRCC). The CheckMate-214 trial demonstrated that combined immunotherapy with the checkpoint inhibitors nivolumab and ipilimumab results in superior outcomes—including significantly better objective response rate (ORR), progression-free survival

IN THIS ISSUE 5 10

Proximal PSA predicts PCa metastasis risk Methylene blue may improve BTX-A injection technique

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PSA screening decreases the risk of PCa-related death

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Active surveillance for very lowrisk PCa is underused

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High-risk PCa has favorableand unfavorable-risk subgroups A hospital emergency department discharge with AKI predicts poor outcomes. PAGE 21

(PFS), and overall survival (OS)— compared with sunitinib among patients with previously untreated intermediate- and poor-risk mRCC. Sunitinib is the current standard of care for this patient population. Bernard Escudier, MD, of Institut Gustave Roussy, Villejuif, France, who presented the study’s fi ndings, said nivolumab/ipilimumab will become the new standard of care for the frontline treatment of these patients. The trial included 1096 patients randomly assigned to receive nivolumab/ ipilimumab (550 patients) or suni-

11.6 mo.

26.5%

8.4 mo. 0

ORR (%)

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Median PFS (mo.)

Source: Escudier B, Tannir N, McDermott D, et al. CheckMate 214: Efficacy and safety of nivolumab + ipilimumab (N+I) v sunitinib (S) for treatment-naïve advanced or metastatic renal cell carcinoma (mRCC), including IMDC risk and PD-L1 expression subgroups. LBA5. Presented at the European Society for Medical Oncology 2017 congress in Madrid, Spain.

tinib (546 patients). With a minimum follow-up of about 17.5 months, the ORR was 41.6% in the nivolumab/ipilimumab arm compared with 26.5% among sunitinib recipients among patients with intermediate- and poorrisk disease. In addition, 9.4% of

patients in the combination therapy arm achieved a complete response compared with 1.2% of patients in the sunitinib arm. Median PFS was 11.6 months in the immunotherapy arm compared with 8.4% in the sunitinib continued on page 11

NMIBC Recurrence, CKD Linked NLR Predicts mRCC Therapy BY NATASHA PERSAUD NMIBC,” lead investigator Tetsutaro CHRONIC KIDNEY disease (CKD) Hayashi, MD, PhD, of Hiroshima Outcomes may increase the risk for recurrence and University in Hiroshima City, Japan, BY JODY A. CHARNOW CHANGES IN NEUTROPHIL-tolymphocyte ratio (NLR) in response to immune checkpoint blockade for metastatic renal cell carcinoma (mRCC) independently predicts outcomes, investigators reported at the European Society for Medical Oncology 2017 Congress in Madrid, Spain. In a study of 142 patients with mRCC who received anti-PD-1/ PD-L1 immune checkpoint blockade (ICB), Aly-Khan A. Lalani, MD, and colleagues at the Dana-Farber Cancer Institute in Boston found that higher 6-week NLR was independently continued on page 11

progression of non-muscle invasive bladder cancer (NMIBC) following transurethral resection, according to researchers. In a study of 418 Japanese patients who underwent transurethral resection of NMIBC, patients with CKD stage G3b–5 had a nearly 2-fold increased risk of recurrence and 3-fold increased risk of progression compared with those who had a CKD stage less than G3b, investigators reported in the International Journal of Urology (2017;24:594-600). “CKD is an independent predictor of recurrence and progression in primary

told Renal & Urology News. “Adding CKD stage to the conventional risk factors could improve the accuracy of risk stratification.” Of the 418 patients, 68.7% had stage G1–2, 23.4% had G3a, and 7.9% had G3b–5 CKD, defined, respectively, as an estimated glomerular fi ltration rate (mL/min/1.73 m2) of 60 or higher, 45–59, and less than 45. Results showed that 57% and 7.7% of patients experienced recurrence and progression, respectively. Over continued on page 11

STRATEGIES FOR LEAVING INDEPENDENT PRACTICE

Options for mergers and partnerships have their pros and cons. PAGE 17

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