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Vol. 44. Issue 9.
Pages 586-596 (November 2020)
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Vol. 44. Issue 9.
Pages 586-596 (November 2020)
Review article
Advances in urologic oncology “OncoForum”: The best of 2019
Avances en uro-oncología «OncoForum»: lo mejor del 2019
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F. Gómez-Veigaa,
Corresponding author
fgveiga@telefonica.net

Corresponding author.
, A. Alcaraz Asensiob, J. Burgos Revillac, J. Cózar Olmod
a Servicio de Urología, Hospital Universitario de Salamanca, Grupo de Investigación Traslacional de Urología (GITUR), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
b Servicio de Urología, Hospital Clínic Universitari, Barcelona, Spain
c Servicio de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain
d Servicio de Urología, Complejo Hospitalario Universitario de Granada, Granada, Spain
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Figures (1)
Tables (6)
Table 1. One-year efficacy results from the KEYNOTE-426 study.
Table 2. OS results in the CARMENA study (median follow-up 50.9 months).
Table 3. Stratification of PCa risk according to age and PSA concentration.
Table 4. Description of the studies and populations included in the meta-analysis.
Table 5. Phase III clinical trials in patients with mHSPC.
Table 6. Bone fractures and cumulative incidence in the EORTC 1333/PEACE III study.
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Abstract
Objective

Review the latest evidence on urologic oncology on kidney, bladder and prostate tumors.

Methods

Abstracts on kidney, bladder and prostate cancer presented at the 2019 congresses (EAU, AUA, ASCO and ESMO) and the publications with the greatest impact in this period, with the highest evaluation by the OncoForum committee, are reviewed.

Results

In patients with metastatic kidney cancer, regimens including immunotherapy (nivolumab+ipilimumab, pembrolizumab) have been shown to be superior to sunitinib in terms of survival. In patients with non-muscle invasive bladder cancer, pembrolizumab has been shown to be an effective alternative in those refractory to bacillus Calmette-Guérin, while in patients with metastatic urothelial cancer, third-line enfortumab vedotin achieved a significant response rate (44%). In patients with localized prostate cancer (PCa), ultrafractionated external radiotherapy did not show any greater acute toxicity than fractionated or hypofractionated radiotherapy. The benefit of enzalutamide and apalutamide associated with castration has been confirmed in M1 PCa patients, regardless of disease volume. In patients with castration-resistant M0 PCa, treatment with enzalutamide, apalutamide or darolutamide has been associated with a delay in the occurrence of metastasis and prolonged survival. Cabazitaxel has demonstrated a survival benefit in patients with metastatic CRPC, while olaparib showed anti-tumor activity after chemotherapy in those tumors with mutations in DNA repair genes.

Conclusions

These data show the implementation of immunotherapy as a novel alternative against renal and bladder cancer. The arrival of new agents for advanced urothelial carcinoma should be highlighted, and the efficacy of enzalutamide and apalutamide in de novo metastatic prostate cancer is established. In metastatic CRPC, cabazitaxel and olaparib (targeting mutations) are promising therapeutic options.

Keywords:
Prostate cancer
Bladder cancer
Kidney cancer
Immunotherapy
Resumen
Objetivo

Conocer las últimas evidencias sobre Urología oncológica de tumores de riñón, vejiga y próstata.

Métodos

Se revisan los resúmenes sobre cáncer renal, de vejiga y de próstata (CaP) presentados en los congresos del año 2019 (EAU, AUA, ASCO y ESMO) y las publicaciones de mayor impacto en este periodo con mayor valoración por parte del comité del OncoForum.

Resultados

En pacientes con cáncer renal metastásico, los regímenes que incluyen inmunoterapia (nivolumab+ipilimumab, pembrolizumab) han mostrado ser superiores a sunitinib en términos de supervivencia. En pacientes con cáncer de vejiga no músculo-invasivo, pembrolizumab ha demostrado ser una alternativa efectiva en aquellos refractarios al bacilo de Calmette-Guérin, mientras que, en pacientes con cáncer urotelial metastásico, enfortumab vedotin en tercera línea logró una tasa de respuesta considerable (44%). En pacientes con CaP localizado, la radioterapia externa ultrafraccionada no mostró mayor toxicidad aguda que la radioterapia fraccionada o hipofraccionada. Se ha confirmado el beneficio de enzalutamida y apalutamida asociados a la castración en pacientes con CaP M1, independientemente del volumen de la enfermedad. En los pacientes con CaP resistente a la castración (CPRC) M0, el tratamiento con enzalutamida, apalutamida o darolutamida se ha asociado con un retraso de la aparición de metástasis y la prolongación de la supervivencia. Cabazitaxel ha demostrado un beneficio en la supervivencia de pacientes con CPRC metastásico, mientras que olaparib mostró actividad antitumoral tras la quimioterapia en aquellos tumores con mutaciones en genes de reparación del ADN.

Conclusiones

Estos datos ponen de manifiesto la incorporación de la inmunoterapia como alternativa novedosa para combatir el cáncer renal y de vejiga. Cabe destacar la llegada de nuevos agentes para líneas avanzadas en el carcinoma urotelial y queda establecida la eficacia de enzalutamida y apalutamida en CaP metastásico de novo. En el CPRC metastásico, cabacitaxel y olaparib (dirigido a mutaciones) son opciones terapéuticas prometedoras.

Palabras clave:
Cáncer de próstata
Cancer de vejiga
Cáncer renal
Inmunoterapia

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