ASCO-GU Highlight - Big coffee gathered, precision first, and look at the GU hot spots

The annual sequence is updated, spring returns to the earth, the ASCO-GU conference held on February 17-19, 2022 will bring an academic feast to doctors in the field of urological oncology around the world
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On March 1st, BeiGene held an online conference "Jeyu · Yubaijia - 2022 ASCO-GU Highlight", inviting many domestic young talents and academic leaders to discuss the progress of ASCO-GU treatment
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The conference invites Professor Zhou Liqun from Peking University First Hospital and Professor Liu Zhuowei from Sun Yat-sen University Cancer Prevention and Control Center as the chairman of the conference.
Professor Zhang Ruiyun from Renji Hospital Affiliated to University School of Medicine gave a keynote speech
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At the beginning of the conference, Professor Liu Zhuowei delivered a speech, saying that in order to improve the overall survival and quality of life of patients, a single treatment method can no longer meet the treatment needs of tumors.
As a surgeon, it is more and more important to fully understand the comprehensive treatment mode of tumors and formulate comprehensive treatment strategies
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This year's ASCO-GU conference brought the latest advances in multiple urological oncology drugs, providing a basis for clinicians to make decisions
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Focus on Frontiers——Immune combined with ADC in the treatment of UC, Professor Li Fan started from the updated points of advanced UC and muscle invasive bladder cancer (MIBC), and shared the progress of urothelial carcinoma (UC) in ASCO-GU.
Meta
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Immunotherapy (IO) + antibody-drug conjugate (ADC) has become the ADC combination treatment plan with the most advanced UC research layout.
According to the TROPHY-U-01 study and the DS8201-A-U105 study, the objective response rate (ORR) has been repeatedly hit.
New high, ADC drugs have a bright future in the era of combination therapy
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However, due to the small sample size of the IO+ADC study and the lack of overall survival (OS) data, the safety is worse than that of monotherapy, so the clinical application still needs more data to support
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For the first-line treatment of platinum-intolerant patients, the previous KEYNOTE 052 study and IMvigor 210 study as well as the ARIES study announced at this conference have confirmed the results of immune monotherapy, while the BAYOU study and LEAP that explored immune combined targeted therapy options The results of the -011 study were not satisfactory.
In the LEAP-011 study, there was no statistical difference in progression-free survival (PFS) and OS between the experimental group and the placebo group
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In addition, although there are no special highlights in various studies of PARP inhibitors, for patients with HRR mutations, PARP inhibitors can still be used as one of the first-line maintenance treatment options
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For the neoadjuvant treatment of MIBC, major guidelines recommend cisplatin-based neoadjuvant chemotherapy, but there is still a lack of standard neoadjuvant therapy for cisplatin-intolerant patients
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ADC monotherapy and IO+ADC have been widely deployed in the perioperative treatment of MIBC.
In EV-103 cohort H, the ORR of Enfortumab vedotin (EV) monotherapy neoadjuvant therapy reached 36.
45%
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Professor Li Fan concluded that the treatment of UC tends to be diversified, immunotherapy is still the mainstream treatment plan at present, and the excellent efficacy of ADC is widely known
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Based on evidence-based standard treatment of immune drugs, Prof.
Ning Hao introduced the updated key points of advanced and perioperative renal cell carcinoma (RCC) at this conference
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Immunotherapy is the cornerstone of first-line treatment of advanced RCC.
The long-term follow-up results of the East Asian subgroup of the CLEAR study and the Checkmate-9ER study were announced at the ASCO-GU conference this year
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The results of the subgroup analysis of the CLEAR study showed that the PFS benefit of the East Asian population (22.
1 vs 11.
1 months, HR=0.
38) was consistent with the overall population (23.
9 vs 9.
2 months, HR=0.
32); the final OS analysis of the Checkmate-9ER study showed that the trial Compared with the control group, the median OS and PFS of the group were significantly prolonged; the efficacy of the new combination nivolumab (Nivo) + axitinib was comparable to that of the existing immune combined TKI regimen
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The above studies once again confirmed the significant survival benefit of immunotherapy plus tyrosine kinase inhibitor (TKI) versus TKI monotherapy, consolidating its status as the first-line standard treatment
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Can a CTLA-4 inhibitor be reinitiated in patients with poor response to PD-1 inhibitor monotherapy? The HCRN GU16-260-Cohort A study explores the timing of the combination of the two, Nivo monotherapy can be used as an alternative first-line treatment for metastatic clear cell renal cell carcinoma (ccRCC), low-risk patients have higher ORR, but Nivo monotherapy After no response, the ORR of CTLA-4 inhibitor was only 11.
4%, and the effect was not ideal
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In addition, Professor Ning Hao said that urologists will be more concerned about the benefits of tumor debulking surgery
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The SWOG 1931 (PROBE) study aims to explore the benefits of cytoreductive surgery in patients treated with combined immunotherapy, with results expected to be published in 2033
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Regarding the neoadjuvant therapy in the perioperative period of RCC, the NeoAvAx study explored the efficacy of immune + TKI as neoadjuvant therapy, which brought new research ideas for the neoadjuvant therapy of RCC, but it still needs large-scale research to verify
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Most of the previous studies on the use of TKIs in the adjuvant treatment of RCC have failed, but the 30-month follow-up results of Keynote564 showed a good DFS benefit, further supporting immunotherapy as the standard regimen for postoperative adjuvant treatment of RCC
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Professor Ning Hao concluded that many studies on immune adjuvant therapy are in full swing and hope to get encouraging results
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After the first session, Prof.
Cui Chuanliang from Peking University Cancer Hospital, Prof.
Zhu Yiping from Fudan University Cancer Hospital, Prof.
Bi Liangkuan from the Second Affiliated Hospital of Anhui Medical University and Prof.
Mu Zhongyi from Liaoning Cancer Hospital participated in the discussion
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Professor Cui Chuanliang believes that the success of EV, goxatuzumab (SG) and other drugs represents that ADC drugs will be a breakthrough point in the treatment of UC, and the use of targeted drugs requires screening of patients from the perspective of molecular pathways
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Professor Zhu Yiping said that immunotherapy currently brings benefits to UC patients, but no matter whether it is immunotherapy monotherapy, dual immune combination or immune combination targeting, very few large-scale phase III studies have really achieved OS benefits.
Continued exploration is still required
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Professor Bi Liangkuan said that the development of immunotherapy has promoted changes in treatment decisions in the UC field, especially neoadjuvant therapy, which has brought good benefits to patients
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Professor Mu Zhongyi affirmed the efficacy of the "Coke combination", and the CLEAR study has enhanced clinicians' confidence in the application of immune combination targeting
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The second part of the conference was presided over by the chairman of the conference, Professor Zhou Liqun
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Professor Zhou Liqun said that as a major international conference, ASCO-GU publishes hundreds of articles every year.
In fact, there are many contributions from our Chinese doctors
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This year's ASCO-GU is rich in content, and there are many advances in UC, RCC and prostate cancer, which have profound guiding significance for clinicians
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Towards Accuracy - MIBC & UC Enters the Era of Precision Medicine Prof.
Zhang Ruiyun gave a speech on "MIBC & mUC Treatment Towards Accuracy".
He believes that from the perspective of this year's ASCO-GU, the treatment focus of MIBC and UC in the era of precision medicine has gradually shifted to how to choose Drugs up
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UC is a highly heterogeneous tumor, and it is still very difficult to precisely locate "Right Tumor" at this stage
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Previous targeted therapy drugs, such as HER2-targeted drugs, PARP inhibitors, and targeting of Nectin-4 and Trop-2, have shown good benefits, but the effect is limited, and further population screening is required.
Therefore, the search for drug combinations has become a major research topic.
hot spot
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Drug combination strategy is a way to overcome the inherent heterogeneity of UC.
Studies such as NORSE, BAYOU, RC48-C014 and other studies suggest that selective small molecule inhibitors and ADCs combined with IO can further improve the efficacy, and the future can be expected
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Neoadjuvant therapy is a key timing for MIBC systemic treatment intervention.
From the SWOG 8710 study, neoadjuvant chemotherapy is still the commonly used treatment option.
For neoadjuvant immunotherapy, most patients are exposed to participating in clinical trials
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Professor Zhang Ruiyun said that the development of imaging, biomarkers and liquid biopsy has promoted more accurate staging and treatment of MIBC
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The Renji Hospital team published the "RJBLC-I2N003 Study - The Efficacy and Safety Study of MIBC Neoadjuvant Immunotherapy" on 2022 ASCO-GU, suggesting that patients receiving immunosingle-agent neoadjuvant therapy have reduced lesions and significant benefits
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Professor Zhang Ruiyun concluded that tailoring MIBC based on prognostic indicators and biomarkers is of great significance for patient mining.
For patients with high-risk characteristics, RC+ systemic therapy is still the standard choice
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For low-risk patients, comprehensive treatment to avoid RC is a hot topic in recent years
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After the speech, under the chairmanship of Professor Zhou Liqun, Professor Zhang Peng of West China Hospital of Sichuan University, Professor Zhang Yong of Cancer Hospital of Chinese Academy of Medical Sciences, Professor Wu Kaijie of the First Affiliated Hospital of Xi'an Jiaotong University and Professor Zhang Zhewei of the Second Affiliated Hospital of Zhejiang University School of Medicine participated in the discussion.

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Professor Zhou Liqun said that the current drug research in the field of urology is flourishing, but not all drug combinations can exert the effect of "1+1>2", and evidence-based medicine still needs to be explored
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Professor Zhang Peng described the application scenarios of immunotherapy, how to control the disease at an early stage through surgery or drug treatment, which is worth thinking about; in addition, tumor treatment has entered the era of precision, and individualized treatment of patients through detection methods , will be the future development trend
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Professor Zhang Yong and Professor Zhang Ruiyun discussed the dose application in the clinical trial of Renji team, which provided a reference for the clinical application of immunotherapy
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Professor Wu Kaijie raised concerns about the potential risks of neoadjuvant immunotherapy and looked forward to more experts sharing clinical application experience
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Finally, Professor Zhang Zhewei said that during the progression of UC, the ATM gene mutation status will change.
In metastatic UC, ATM inhibitors cannot kill tumor cells, while in superficial UC, radiation or chemotherapy combined with ATM inhibition is used.
When treated with the drug, more cells can undergo apoptosis, so Professor Zhang also agrees that controlling the tumor treatment at an early stage can benefit patients more
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At the end of the summary meeting, Professor Zhou Liqun delivered a speech
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The three speakers reported on the best research on UC and RCC in ASCO-GU, and the results of Yan Chai Hospital's research in ASCO-GU are also encouraging
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It is hoped that the heated discussion tonight will be helpful to the clinical diagnosis and treatment of urological oncologists
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As a urologist, not only must play a good scalpel, but also keep up with the frontier, keep up with practical facts, understand the development of drugs, comprehensively measure treatment decisions, and bring more benefits to patients! Scan the QR code below to watch the wonderful replay Edit: Bingxin Typesetting: Uni Execution: XY Classroom, scan the code to enter▼▼▼