Genitourinary Cancers

 

Based on results of the Prostate Cancer Prevention Trial (PCPT) and the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial, the US Food and Drug Administration (FDA) has updated the Warnings and Precautions sections of the labels for the 5-alpha reductase inhibitor (5-ARI) drug class. These trials showed that daily use of finaseride and dutasteride reduced overall incidence of prostate cancer (mainly low-grade), but increased the incidence of high-grade prostate cancers.

 

 

Based on results of the Prostate Cancer Prevention Trial (PCPT) and the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial, the US Food and Drug Administration (FDA) has updated the Warnings and Precautions sections of the labels for the 5-alpha reductase inhibitor (5-ARI) drug class. These trials showed that daily use of finaseride and dutasteride reduced overall incidence of prostate cancer (mainly low-grade), but increased the incidence of high-grade prostate cancers.

 

For women with stage II to III estrogen receptor–rich, HER2-negative breast cancer, neoadjuvant aromatase inhibitor (AI) therapy can increase the likelihood of successful breast-conservation surgery. According to phase 2 results of American College of Surgeons Oncology Group Z1031, exemestane, letrozole, and anastrozole are biologically equivalent and therefore likely to achieve similar adjuvant activities. The researchers concluded that because this is a low-toxicity approach, neoadjuvant AI therapy is a reasonable standard of care for selected members of this population.

Clear cell (CC)-renal cell carcinoma (RCC), the predominant histologic type of RCC, is highly dependent on angiogenesis, via the vascular endothelial growth factor (VEGF) pathway.1 The mammalian target of rapamycin (mTOR) pathway also appears to play a role in VEGF production, as well as directly promote tumor cell growth.

When initial androgen-deprivation therapy (ADT) fails to control progression of metastatic prostate cancer, the disease is redefined as castration-resistant prostate cancer (CRPC). Studies have shown that using docetaxel and prednisone to treat men with CRPC only modestly extends median overall survival (OS) to ~19 months.

The US Food and Drug Administration (FDA) approved abiraterone acetate (Zytiga, Centocor Ortho Biotech) in combination with prednisone to treat patients with metastatic castration-resistant prostate cancer who have received prior docetaxel-based chemotherapy.

 

This oral oncolytic targets CYP 17A1, which plays an important role in the production of testosterone. The drug works by decreasing the production of this hormone that would stimulate cancer cells to continue growing.

 

The Centers for Medicare & Medi caid Services (CMS) has re leased a proposed decision memo that suggests it will cover the cost of sipuleucel-T (Provenge), the immunotherapy vaccine approved in April 2010 for men with asymptomatic or mildly symptomatic metastatic castrate-resistant prostate cancer, for on-label use. CMS contractors will have discretion as to whether they will cover it for off-label use.

Interim results of a randomized, controlled, phase 3 trial showed that abiraterone acetate significantly prolonged overall survival (OS) in patients with metastatic castration-resistant prostate cancer (CRPC) who progressed after docetaxel-based chemotherapy. The survival benefit was consistent across all prespecified subgroups. Lead author Howard Scher, MD, Memorial Sloan-Kettering Cancer Center, New York, said abiraterone is poised to become a new standard of care.

Adding androgen-deprivation therapy (ADT) to dose-escalated external beam radiotherapy (EBRT) for men with intermediate-risk prostate cancer improves biochemical failure-free survival but not overall survival (OS), according to a retrospective study. Researchers from Emory University School of Medicine and the Atlanta Veterans Administration in Georgia conducted the study.

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