Renal & Urology News - March/April 2018

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M A R C H /A P R I L 2 0 1 8

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V O L U M E 17, I S S U E N U M B E R 2

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www.renalandurologynews.com

PCa Drugs Decrease Metastasis Risk Apalutamide and enzalutamide prolong metastasis-free survival in men with non-metastatic CRPC IMPROVED METASTASIS-FREE SURVIVAL In separate studies of men with non-metastatic castration-resistant prostate cancer who continued to receive androgen-deprivation therapy (ADT), those treated with apalutamide or enzalutamide had longer metastasis-free survival than those who received placebo. Shown here are the median survival times in months. 50

MONTHS

40

40.5

36.6

30

16.2

20

14.7

10 0

Apalutamide

Placebo

Enzalutamide

Placebo

Sources: Smith MR, Saad F, Chowdhury S, et al. Apalutamide treatment and metastasis-free survival in prostate cancer. N Engl J Med. 2018; published online ahead of print. Hussain M, Fizazi K, Saad F, et al. PROSPER: A phase 3, randomized, double-blind, placebo (PBO)-controlled study of enzalultamide (ENZA) in men with nonmetastatic castration-resistant prostate cancer (M0 CRPC). Data presented at the 2018 Genitourinary Cancers Symposium. Abstract 3.

CN Ups Survival Odds in mRCC SAN FRANCISCO—New study findings presented at the 2018 Genitourinary Cancers Symposium may help to clarify the role of cytoreductive nephrectomy (CN) in the treatment of metastatic renal cell carcinoma (mRCC). Bimal Bhindi, MD, and colleagues at Mayo Clinic in Rochester, Minnesota,

showed that upfront CN may offer better survival in appropriate surgical candidates compared with first-line targeted treatment. In another study, Jeffrey Graham, MD, of Tom Baker Cancer Centre at the University of Calgary in Alberta, Canada, and colleagues found that CN for mRCC continued on page 30

POINTS TO CONSIDER IN LYMPHOCELE PREVENTION

Strategies may include creating a peritoneal advancement flap. PAGE 15

BY JODY A. CHARNOW SAN FRANCISCO—Treatment of non-metastatic castration-resistant prostate cancer (CRPC) with apalutamide or enzalutamide, both orally administered androgen receptor inhibitors, prolongs metastasis-free survival (MFS), according to the findings of separate studies presented at the 2018 Genitourinary Cancers Symposium. Apalutamide is a next-generation medication that received FDA approval on February 14 for use in men with non-metastatic CRPC. Enzalutamide received FDA approval for treating metastatic CRPC in August 2012, but is not yet approved for use in men with non-metastatic CRPC.

For Untreated mRCC, Combo May Be Better BY JODY A. CHARNOW COMBINED TREATMENT with atezolizumab and bevacizumab for untreated metastatic renal cell carcinoma (mRCC) is associated with better progression-free survival (PFS) compared with sunitinib, according to study findings presented at the 2018 Genitourinary Cancers Symposium. The benefit appears to be greater in patients with PD-L1 positive tumors. The phase 3 study (IMmotion151), which began in 2015, enrolled 915 adult patients with mRCC who were randomly assigned to receive the immunotherapy atezolizumab plus the targeted therapy bevacizumab intravenously every 3 weeks or sunitinib, an orally administered drug, daily for 4 weeks, followed by 2 weeks off treatment. Atezolizumab is an immune checkpoint inhibitor that blocks the PD-L1 protein on tumor cells, thereby allowing the immune system to recognize and attack those cells. Bevacizumab continued on page 30

In the phase 3, randomized, doubleblind, placebo-controlled SPARTAN trial, men with non-metastatic CRPC treated with apalutamide had a significant 72% lower risk of metastasis or death compared with placebo recipients, with a median 2-year improvement in MFS, said lead investigator Eric Jay Small, MD, Professor and Chief, Division of Hematology and Oncology, University of California, San Francisco (UCSF), and Deputy Director of the UCSF Helen Diller Family Comprehensive Cancer Center, who presented study findings at the symposium. In addition, the investigators observed a 55% risk reduction in time to symptomatic progression. The continued on page 30

IN THIS ISSUE 6

Testosterone therapy does not elevate cardiovascular risks

19

Statins tied to better survival in men with advanced PCa

19

Perioperative aspirin use need not contraindicate RP

21

Meropenem-vaborbactam found superior for complicated UTI

22

Aspirin may ease vasculogenic erectile dysfunction

28

Urgency urinary incontinence linked to prior stroke or TIA

31

Ultra-low contrast volume could reduce CIN risk

A single PSA screening test has no effect on prostate cancer death risk. PAGE 28


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