Oncologists treating GU cancers are learning best practices for managing side effects of newer drugs like TDXD and Capivasertib from breast cancer experts, who have a longer history and more granular knowledge of using these agents effectively and safely.
Unlike traditional immunotherapies, T-cell engagers like PestRitaMeg are demonstrating success in prostate cancer. They offer a favorable safety profile with low cytokine release syndrome (CRS) rates and convenient outpatient dosing, potentially overcoming a major hurdle in this disease.
The combination of enfortumab vedotin and pembrolizumab is not just improving median survival in metastatic bladder cancer; it's creating a "tail on the curve," suggesting a subset of patients may achieve long-term durable responses, a rarity in this advanced setting.
For younger, fit patients with high-risk localized prostate cancer, the PROTEUS study provides data for a new treatment paradigm: perioperative ADT with apalutamide surrounding a radical prostatectomy. This offers a compelling surgical-based alternative to standard radiation-focused therapies.
Unlike older studies with ADT monotherapy, the EMBARC and ADREEM trials show that with modern drug combinations and PSMA PET imaging, intermittent therapy is a viable strategy. This allows for safe treatment breaks that improve quality of life by enabling testosterone recovery.
The CAPItello-281 trial shows the benefit of the AKT inhibitor capivasertib is on a spectrum. Patients with 100% PTEN protein loss by IHC derive a much greater benefit than those with partial loss, suggesting a quantitative biomarker may optimize patient selection.
Patients with high-risk genomic features like PTEN or TP53 loss may develop new or worsening metastatic disease visible on imaging without a rise in their PSA levels. This mandates routine cross-sectional imaging, as PSA alone is an unreliable marker for progression in this subgroup.
Clinicians are viewing PSMA PET scans as a quantitative tool, not just a binary test. Patients with very "bright" scans (high SUV, e.g., >10) may be the ideal candidates for Lutetium-PSMA radioligand therapy, suggesting avidity predicts the magnitude of benefit.
The TAR-200 "pretzel" is an intravesical device designed to remain in the bladder and slowly release drugs like gemcitabine over an extended period. This novel engineering feat overcomes the key limitation of traditional instillations—short drug contact time with the urothelium.
While post-cystectomy ctDNA can guide adjuvant therapy decisions in treatment-naive patients, its interpretation is now complex. For patients who received neoadjuvant immunotherapy (like EV-Pembro), the meaning of a positive or negative ctDNA result is unknown, and prior trial data cannot be extrapolated.
Neoadjuvant EV-Pembro yields pathologic complete response rates near 60% in muscle-invasive bladder cancer. This high efficacy has prompted multiple large-scale clinical trials to test whether radical cystectomy can be safely avoided in select patients, a potentially practice-defining change.
In high-risk kidney cancer, post-operative ctDNA tests have low sensitivity, detecting residual disease in only ~30% of patients. Despite this, a positive result is highly prognostic, identifying a subgroup with a significantly poorer outlook and high likelihood of recurrence.
Anemia is an on-target, expected side effect of the HIF2-alpha inhibitor belzutafan. Experienced clinicians proactively manage this by starting erythropoietin-stimulating agents (ESAs) when hemoglobin falls below 9 g/dL, and sometimes place the order preemptively to avoid treatment delays.