Oncology Decoded

• 4: Adjuvant Therapy and Post-Surgical Management Options for Kidney Cancer

  In the most recent episode of Oncology Decoded, co-hosts Manojkumar Bupathi, MD, MS, executive co-chair of Genitourinary Cancer Research Executive Committee at Sarah Cannon Research Institute and medical oncologist with Rocky Mountain Cancer Centers specializing in solid tumors and genitourinary cancers; and Benjamin Garmezy, MD, associate director of Genitourinary Research and executive co-chair of Genitourinary Cancer Research Executive Committee at Sarah Cannon Research Institute (SCRI) and medical oncologist at SCRI Oncology Partners specializing in genitourinary cancers, engaged in a detailed discussion focused on adjuvant therapy for kidney cancer, providing key insights regarding available treatment options.     The discussion began with defining adjuvant therapy that aims to improve disease-free survival, overall survival, or both. The hosts explore effective ways to communicate the goals and potential benefits of adjuvant therapy to patients, acknowledging the challenge of recommending treatment to patients who may feel they are already “cured” after surgery.     The conversation transitioned to the specifics of adjuvant therapy in renal cell carcinoma (RCC), with a focus on clear cell RCC.  Bupathi and Garmezy discussed the evolution of treatment strategies from VEGF tyrosine kinase inhibitors (TKIs) to immunotherapy.  They highlighted the significance of the phase 3 KEYNOTE-564 trial (NCT03142334), which supported the approval of adjuvant pembrolizumab (Keytruda), a PD-1 inhibitor, for certain patients who are high-risk. Additionally, they highlighted other immunotherapy trials and the distinction between PD-1 and PD-L1 inhibitors.     The discussion also touched upon patient selection for adjuvant pembrolizumab, with the hosts sharing their individual approaches. Factors influencing treatment decisions include disease stage, risk of recurrence, patient comorbidities, and potential treatment toxicities.  The importance of shared decision-making with patients is emphasized, particularly regarding the balance between potential benefits and risks of treatment.     Finally, practical guidance on managing treatment-related toxicities, including strategies for monitoring patients and addressing potential adverse effects, was mentioned. They also discuss the complexities of monitoring patients’ post-treatment, including the use of CT scans and the management of pulmonary nodules. The discussion extends to managing progressive disease in patients who have received adjuvant therapy, including the role of VEGF TKIs and clinical trials.    

  --------  

  38:59
• 3: Traversing the Complexities of Non-Clear Cell Renal Cell Carcinoma

  This episode of Oncology Decoded tackled the challenging landscape of non-clear cell renal cell carcinoma (nccRCC), a heterogeneous group of tumors representing about 20% to 25% of all kidney cancers. The episode provided expert insights into the diagnosis and management of this complex disease.  Meet the panel discussants:  Manojkumar Bupathi, MD, MS, executive co-chair of Genitourinary Cancer Research Executive Committee at Sarah Cannon Research Institute; medical oncologist with Rocky Mountain Cancer Centers specializing in solid tumors and genitourinary cancers; Benjamin Garmezy, MD, associate director of Genitourinary Research and executive co-chair of Genitourinary Cancer Research Executive Committee at Sarah Cannon Research Institute (SCRI); medical oncologist at SCRI Oncology Partners specializing in genitourinary cancers; Stephanie A. Berg, DO, medical oncologist for the Lank Center of Genitourinary Oncology at Dana-Farber Cancer Institute. The conversation centered around a case presentation: a 63-year-old female with papillary RCC, presenting with significant weight loss, cough, a large renal mass, and multiple pulmonary and bone metastases. The panel emphasized the importance of accurate pathological diagnosis, highlighting the diverse subtypes within nccRCC, including papillary, chromophobe, translocation, and collecting duct carcinomas. They acknowledged the limitations of historical treatment approaches, which have yielded suboptimal response rates and progression-free survival (PFS). The discussion then delved into the evolving treatment landscape, focusing on recent clinical trial data. The phase 2 PAPMET trial (NCT02761057) of cabozantinib (Cabometyx) vs sunitinib (Sutent) in patients with advanced RCC. The emergence of newer VEGF-selective TKIs, such as tivozanib (Fotivda), also showed promise in disease control. The panel highlighted the growing role of immunotherapy (IO) in nccRCC, particularly the combination of cabozantinib and nivolumab (Opdivo), which showed encouraging response rates in non-chromophobe subtypes. Similarly, the combination of lenvatinib and pembrolizumab demonstrated significant PFS and overall response rates across various nccRCC subtypes, including chromophobe. In the absence of clinical trials, the panel recommended a personalized approach to treatment, considering the patient's subtype, disease burden, and comorbidities. They generally favored IO-TKI combinations, such as lenvatinib plus pembrolizumab, for most patients with nccRCC, while acknowledging the potential role of ipilimumab (Yervoy) plus nivolumab (Opdivo) in select cases, particularly those with chromophobe histology and low disease burden. The panel also addressed the role of radiation therapy in nccRCC, particularly for oligometastatic disease and oligoprogressive disease. They emphasized the importance of multidisciplinary collaboration with radiation oncologists to optimize treatment strategies. Regarding molecular testing, the panel acknowledged its limited role in guiding treatment decisions at present but highlighted its potential to identify patients with specific genetic alterations, such as MET amplification or FH deficiency, who may benefit from targeted therapies or germline testing. Finally, challenges of sequencing therapies in nccRCC were discussed, emphasizing the lack of definitive data and the need for individualized treatment decisions. They generally favored sequencing TKIs, such as tivozanib or sunitinib, after progression on IO-TKI combinations, but acknowledged the need for further research to optimize treatment sequencing. Reference  Tripathi A, Tangen C, Li X, et al. Pathologic concordance rate and outcomes by histologic subtype in advanced papillary renal cell (pRCC) carcinoma: An analysis from the SWOG S1500 (PAPMET) trial. J Clin Oncol. 2023;41(suppl 16):4562. doi:10.1200/JCO.2023.41.16_suppl.4562 Physicians’ Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Physicians’ Education Resource®, LLC, designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Instructions on How to Receive Credit Listen to this podcast in its entirety. Go to gotoper.com/credit and enter code: 8926 Answer the evaluation questions. Request credit using the drop-down menu. You may immediately download your certificate.

  --------  

  25:30
• 2: Navigating Treatment Intensification in Metastatic Hormone-Sensitive Prostate Cancer

  When treating hormone-sensitive prostate cancer (mHSPC), one question can be, when is the right time to optimize or intensify therapy? In the latest Oncology Decoded podcast, genitourinary oncologists discuss the use of radiotherapy and define oligometastatic disease including preferred treatment options. The discussion took place during the 2025 ASCO Genitourinary Cancers Symposium.  The expert panel consisted of:     Manojkumar Bupathi, MD, MS, executive co-chair of Genitourinary Cancer Research Executive Committee at Sarah Cannon Research Institute; medical oncologist with Rocky Mountain Cancer Centers specializing in solid tumors and genitourinary cancers; Benjamin Garmezy, MD, associate director of Genitourinary Research and executive co-chair of Genitourinary Cancer Research Executive Committee at Sarah Cannon Research Institute (SCRI); medical oncologist at SCRI Oncology Partners specializing in genitourinary cancers; David Morris, MD, MS, president of Urology Associated, PC; Tanya Dorff, MD, professor in the Department of Medical Oncology & Therapeutics Research and section chief of the Genitourinary Disease Program at City of Hope; Mark T. Fleming, MD, medical oncologist at Virginia Oncology Associates; disease chair of the Genitourinary Cancer Research Executive Committee for SCRI at Virginia Oncology Associates. The discussion centered around a challenging case of a 50-year-old male who had hematuria, penile pain, and a high prostate-specific antigen, with imaging revealing a Gleason 4+5 adenocarcinoma and metastatic lymph node involvement. The panel agreed that androgen deprivation monotherapy was insufficient for this patient. The conversation quickly shifted to the optimal intensification strategy, with a focus on balancing efficacy and toxicity. Morris advocated for a combination of radiotherapy and androgen deprivation therapy (ADT) plus an androgen receptor signaling inhibitor, while acknowledging the patient didn’t strictly meet criteria for triplet therapy with chemotherapy. Dorf and Fleming favored doublet therapy with an androgen receptor pathway inhibitor and radiation, but also highlighted the importance of discussing chemotherapy, particularly given the patient’s young age and aggressive disease characteristics. A key point of contention was the role of docetaxel. While some panelists acknowledged its potential benefit, concerns about toxicity and the lack of clear high-burden disease criteria in this case led to a general preference for radiation therapy for local debulking. The discussion also explored the concept of oligometastatic disease, with the panel generally agreeing on a threshold of less than 5 metastatic sites. However, the location of these sites was deemed crucial, with lymph node and bone metastases considered more amenable to radiation therapy than visceral involvement. The importance of multidisciplinary input, including radiation oncology, was emphasized in determining the optimal treatment approach. The use of imaging for surveillance was another key topic. While PSMA PET imaging was considered the gold standard for sensitivity and specificity, challenges with insurance coverage and the need for consistent imaging modalities were acknowledged. The panelists also highlighted the importance of considering de-differentiation and the potential for false positives with PSMA PET scans. Ultimately, the discussion underscored the importance of individualized treatment decisions in mHSPC, considering patient age, disease burden, risk factors, and preferences. The panel emphasized the need for ongoing research to refine treatment strategies and improve outcomes for patients with this complex disease. Physicians’ Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Physicians’ Education Resource®, LLC, designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Instructions on How to Receive Credit Listen to this podcast in its entirety. Go to gotoper.com/credit and enter code: 3541 Answer the evaluation questions. Request credit using the drop-down menu. You may immediately download your certificate.

  --------  

  26:21
• 1: NIAGARA Study is the Forefront of Post-ASCO GU Discussion in Bladder Cancer

  During the 2025 ASCO Genitourinary Cancers Symposium, Oncology Decoded held their inaugural podcast with a live filming taking place at the conference. The first episode focused on bladder cancer specifically, neoadjuvant vs adjuvant therapy options and the use of cisplatin vs carboplatin.  Meet the expert panel involved in the discussion:     Manojkumar Bupathi, MD, MS, executive co-chair of Genitourinary Cancer Research Executive Committee at Sarah Cannon Research Institute; medical oncologist with Rocky Mountain Cancer Centers specializing in solid tumors and genitourinary cancers; Benjamin Garmezy, MD, associate director of Genitourinary Research and executive co-chair of Genitourinary Cancer Research Executive Committee at Sarah Cannon Research Institute (SCRI); medical oncologist at SCRI Oncology Partners specializing in genitourinary cancers' Petros Grivas, MD, PhD, professor in the Clinical Research Division and clinical director of Genitourinary Cancers Program at Fred Hutch Cancer Center; David Morris, MD, MS, president of Urology Associated, PC. During the discussion on neoadjuvant therapy, the panelist brought up results from the phase 3 NIAGARA trial (NCT03732677) which assessed durvalumab (Imfinzi) along with radical cystectomy and adjuvant chemotherapy followed by radical cystectomy.  For those who achieved a pathological complete response (pCR), the median overall survival (OS) was not reached (NR) in the durvalumab arm or the comparator arm (HR, 0.72; 95% CI, 0.387-1.426). For those who did not have a pCR, the median OS was NR in both arms as well (HR, 0.84; 95% CI, 0.660-1.068). The intent-to-treat (ITT) population OS HR was 0.75 (95% CI, 0.59-0.93).  In the ITT population, the pCR was 37.3% (95% CI, 33.2%-41.6%) in the durvalumab arm and 27.5% (95% CI, 23.8%-31.6%) in the comparator arm (OR, 1.60-1.23-2.08).  Results from this trial then led into the use of cisplatin vs carboplatin. From a urologist perspective, Morris notes that all patients should be afforded the opportunity for neoadjuvant therapy vs being thrown right into surgery. He also mentions this scenario can occur because of the criteria for administering cisplatin.  “If I had one message today for our friends and colleagues in practice, do not use carboplatin in the neoadjuvant setting. If you can give cisplatin, we can talk about who can be cisplatin-eligible. If you cannot give cisplatin safely, the options could be radical cystectomy upfront with liminal dissection or clinical trial, if available and eligible, and bladder preservation can be another strategy in these patients,” Grivas said.  Grivas backed up his reasoning here because of clinical trials that have been conducted regarding pCR rates. These rates appeared to be lower in those given carboplatin vs those given cisplatin. Because of this, he will not use carboplatin as a neoadjuvant or adjuvant approach for muscle-invasive bladder cancer.  Moving forward, they hope to focus on capturing additional data from real-world studies as well as more trials to provide evidence-based research for the treatment of bladder cancer.  Reference Galsky M, Van Der Heijden M, Catto J, et al. Additional efficacy and safety outcomes and an exploratory analysis of the impact of pathological complete response (pCR) on long-term outcomes from NIAGARA. J Clin Oncol 43, 2025 (suppl 5; abstr 659). Physicians’ Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Physicians’ Education Resource®, LLC, designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Instructions on How to Receive Credit Listen to this podcast in its entirety. Go to gotoper.com/credit and enter code: 4376 Answer the evaluation questions. Request credit using the drop-down menu. You may immediately download your certificate.

  --------  

  33:13

More Science podcasts

Trending Science podcasts

About Oncology Decoded