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- Experts at the 2025 World Conference on Genitourinary Cancers discussed specialized treatment strategies for variant histologies in prostate, bladder, and kidney cancers, including small cell and neuroendocrine differentiation subtypes. - The conference emphasized the importance of risk stratification tools like Decipher Prostate scores, MRI scans, and PSA levels for optimizing surveillance and treatment decisions in community oncology settings. - Novel therapeutic combinations such as enfortumab vedotin-ejfv plus pembrolizumab for bladder cancer variants and the development of new intravesical therapies were highlighted as expanding treatment options. - Multidisciplinary collaboration between medical oncologists and urologists was identified as crucial for managing complex genitourinary malignancies and implementing appropriate surveillance strategies in community practice.
- PSMA PET imaging has revolutionized prostate cancer detection and management, particularly in biochemical recurrence settings, with multiple FDA-approved agents now available including gallium-68 PSMA-11, piflufolastat F 18, and flotufolastat F 18. - The newer agent flotufolastat F 18 offers unique advantages in postprostatectomy recurrence scenarios due to its reduced bladder activity, allowing better visualization of potential recurrence in the prostate bed. - While PSMA PET has largely replaced fluciclovine F 18, the metabolic tracer still maintains a role in specific scenarios including tumors with low PSMA expression and neuroendocrine differentiation cases. - Expert panels emphasize that agent selection often depends on institutional availability and specific clinical contexts, as detection rates and sensitivity remain comparable between different PSMA PET tracers.
- A recent survey of 103 oncologist-hematologists shows tumor lysis syndrome management and clinical logistics are primary concerns in venetoclax initiation for CLL treatment. - Only one-third of community physicians regularly prescribe fixed-duration venetoclax therapy, despite its potential cost advantages over indefinite BTK inhibitor treatment. - The AMPLIFY study investigating fixed-duration acalabrutinib-venetoclax combination shows promise as a potential new all-oral treatment option for frontline CLL therapy.
- Mosunetuzumab demonstrates a high objective response rate of 95% and a complete metabolic response rate of 83.3% in previously untreated, low-tumor burden follicular lymphoma patients. - The Morningsun trial reveals a manageable safety profile for mosunetuzumab, with injection-site reactions and cytokine release syndrome being the most common adverse events. - Ongoing trials, including SWOG-2308, are comparing mosunetuzumab with rituximab to further evaluate its efficacy in low-tumor burden follicular lymphoma. - Further research is needed to identify potential subgroups that may experience increased benefit with mosunetuzumab beyond different lines of therapy.
- Dr. Mabel Mardones emphasizes the critical importance of bringing clinical trials to community settings, highlighting the need for collaboration between pharmaceutical companies, academic centers, and community practices. - The expert calls attention to the significant underrepresentation of minorities in clinical trials, noting they comprise less than 5% of trial participants, prompting FDA prioritization of this issue. - Dr. Mardones advocates for dismantling provider biases, increasing diverse physician representation, and utilizing community resources to enhance trial accessibility for underserved populations.
- Rocky Mountain Cancer Centers' executive director warns that inaccurate AI outputs could damage physician confidence in the technology for months, emphasizing the need for careful implementation. - Healthcare leaders advocate for experimental demonstration projects to understand both AI capabilities and provider responses before widespread adoption in oncology practices. - Experts stress the importance of maintaining physician autonomy and accountability while integrating AI tools into cancer care workflows.
