Update in systemic therapy of urologic malignancies
David Mooney1, Ravikumar Paluri, Amitkumar Mehta
1University of Alabama, Birmingham (UAB) Comprehensive Cancer Center, Birmingham, AL.
Postgraduate Medicine
|January 8, 2014
Summary
Recent advances in systemic therapy for advanced prostate and renal cancers include new immunotherapies, chemotherapies, and targeted agents, significantly improving survival for these urologic malignancies.
Area of Science:
- Urologic Oncology
- Medical Oncology
- Cancer Therapeutics
Background:
- Advanced prostate and renal cancers have seen significant therapeutic advancements.
- Castration-resistant prostate cancer (CRPC) treatment now includes immunotherapy, chemotherapy, and novel hormonal agents.
- Renal cell carcinoma (RCC) therapy has evolved due to understanding angiogenesis, incorporating VEGF and mTOR inhibitors.
Purpose of the Study:
- To review and update the field of systemic therapy for advanced urologic malignancies.
- To focus on recent therapeutic additions for CRPC and RCC.
- To highlight advancements in cancer treatment strategies.
Main Methods:
- Review of recent clinical trial data and therapeutic approvals.
- Summary of systemic agents for advanced prostate and renal cancers.
- Analysis of treatment outcomes and survival benefits.
Main Results:
- CRPC treatment expanded with sipuleucel-T, cabazitaxel, abiraterone acetate, enzalutamide, and alpharadin.
- RCC therapy now includes multiple VEGF inhibitors (sorafenib, sunitinib, pazopanib, axitinib, bevacizumab) and mTOR inhibitors (temsirolimus, everolimus).
- Immunotherapy remains crucial for RCC, with IL-2 and emerging agents showing benefit.
Conclusions:
- Systemic therapy for advanced CRPC and RCC has dramatically improved patient survival.
- While other urologic cancers have seen fewer advances, testicular germ cell tumors remain highly curable.
- Vinflunine represents a new second-line option for advanced urothelial cancer in some regions.
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