Prospects and current developments in focal and immunotherapies were discussed in the second-day plenary sessions at the 17th Central European Meeting (CEM) with experts examining the expected benefits in emerging technologies.
In the session on treatment of prostate cancer, M. Rebek (SL) and H. Klinger (AT) took up radical prostatectomy and focal therapies, respectively. Rebek assessed the performance of radiotherapy (RT) and radical prostatectomy (RP) in high-risk prostate cancer (PCa).
Rebek said majority of registry studies showed improved cancer control and survival outcomes for men treated with RP. He also discussed the role of RP in node-positive PCa, although there is the dilemma when faced with the options RP plus pelvic lymph node dissection (PLND) versus RT plus androgen deprivation therapy (ADT). In his concluding remarks Rebek said the role of surgery and RT in high-risk PCa “…is an established component of multimodal treatment.”
“Ongoing clinical trials in cytoreduction in metastatic PCa will help guide evolution of multimodal treatment,” said Rebek. “However, current guidelines relegate the use of focal radiotherapy for palliative treatment and preclude the use of surgery in any of the algorithms for treatment of overt metastatic disease.”
Rebek also expects the rapid growth in knowledge for multimodal treatment of node positive and metastatic disease. “There will be a massive expansion of the armamentarium of available therapies for advanced carcinoma,” he added.
Klinger discussed focal therapies and looked into various treatment options such as radiofrequency, cryotherapy, focused ultrasound and thermal laser, among others. “Focal tumor ablation is feasible at low morbidity,” he said and mentioned that some of the most crucial issues are properly identifying and localizing ‘suitable’ tumors, monitoring tissue ablation and defining the parameters of a successful procedure.
Meanwhile, the session on urothelial tumors included lectures on how to perform a good TURB given by A. Kolodzeij (PL) and a comprehensive overview of immunotherapy in bladder cancer presented by Prof. G. Gluck (RO).
Kolodzeij noted TURB as a critical step in treating non-muscle invasive bladder cancer (NMIBC). “It may be more important than any intravesical therapy. But a dedicated TURB training programme should be implemented in each urological ward,” she stressed. She also expects that advanced endoscopic imaging technology and, perhaps, en bloc tumor resection “should soon raise the quality of TUR.”
Gluck presented the historical and future prospects in bladder cancer immunotherapy going through a range of treatments and issues such as BCG, cytokines, immune checkpoints modulators, vaccines, oncolytic viruses and combination therapies.
“Who benefits from immunotherapy? Patients with higher expression of PD-L1 had higher rate of response,” said Gluck. According to Gluck, currently ongoing trials will clarify the role of immune checkpoint agents as first-line treatment, compared to platinum-based chemotherapy.
“The absence of obvious differences in efficacy emerges in indirect comparison of clinical trials, and we do not know which the best treatment choice is,” he said while pointing out that based on the final results of these trials, the treatment for patients with advanced urothelial cancer could soon change than what is prescribed in current guidelines.