When I was a urology resident in the early 2000s, the management of any advanced genitourinary cancer was challenged by a frustrating lack of available treatments that could prolong the lives of individuals with cancer. The chemotherapy we used for prostate cancer was associated with quality-of-life benefit, but no survival benefit. If bladder cancer did not respond to the initial rounds of chemotherapy, we usually transitioned to palliative care. And kidney cancer was managed with nonspecific immunotherapies that were either incredibly challenging to give or that were associated with limited improvements in survival. As the articles in this issue highlight, the rapid development of new treatments for localized and advanced genitourinary cancers is challenging our paradigms of care and readjusting our treatment algorithms on a regular basis.

We are moving from an era of monotherapies to better understanding how combinations of treatments with different mechanisms of action can work together to help patients have better survival and quality of life outcomes. Combining drugs that block the impact of androgens on prostate cancer cells with drugs that keep cancer cells from repairing their own DNA so that they cannot divide and make more cancer cells is associated with patients living longer with advanced prostate cancer. Combining traditional chemotherapies with drugs that block cancer cells escape mechanisms that allow them to evade our immune system was associated with better survival in bladder cancer that invades the outer muscle layer of the bladder.

New advancements can also mean learning how to optimize treatments. The IMvigor211 trial was the first demonstrating the benefit of immune checkpoint inhibitors in metastatic bladder cancer. Yet in these large trials, we usually learn the difference in outcome for the average patient in a trial. 

Some patients do better than average, and some do worse. Learning what additional factors can help patients have better health outcomes is a great motivator for secondary analyses of these trials, even ones published almost 10 years ago. In the case of the study highlighted in this issue, that means assessing the potential benefit of combining the immunotherapy with antihistamine medications. Sometimes, that means using biomarkers like the presence of circulating tumor DNA to better select patients for additional therapies. Either way, these secondary studies of large-scale trials help us as clinicians talk to patients when they ask us what they can do to optimize their health outcomes with these treatments.

Included in these studies are the individual experiences of hundreds of patients navigating their journeys with prostate cancer, bladder cancer, kidney cancer, testicular cancer and others. These are experiences that cannot be summed up in the aggregate data of these trials, because for these individuals, the trial has a sample size of one. 

Beyond understanding traditional outcomes for clinical trials like progression of the cancer, recurrence of the cancer or death from the cancer, more and more studies are examining the patient experience. Whether new therapies that make survival better, or additional adjuncts to treatment that make that treatment work better, underlying all of these studies is the impact on patient experience with their cancer.

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Articles

The management of advanced genitourinary cancers has evolved significantly since the early 2000s, with new treatments improving survival and quality of life. The shift from monotherapies to combination therapies, such as androgen blockers with DNA repair inhibitors for prostate cancer, has shown promising results. Trials like IMvigor211 highlight the benefits of immune checkpoint inhibitors in bladder cancer, while secondary analyses explore factors like antihistamines and biomarkers to optimize outcomes. Patient experiences remain crucial, emphasizing the importance of personalized care and understanding beyond aggregate trial data.

New treatment combinations are transforming genitourinary cancer care, improving survival and quality of life while personalizing patient outcomes.

Rapid Developments to Enhance Patient Experience in GU Cancer

Antihistamines are associated with improvements in progression-free events and survival outcomes for patients with metastatic urothelial carcinoma (mUC) receiving Tecentriq (atezolizumab), research has shown.

Drawing on data from 896 patients from the phase 2 IMvigor210 trial and phase 3 IMvigor211 trial, researchers published their findings in Urologic Oncology: Seminars and Original Investigations. They found that at two years, the overall survival (OS), cancer-specific survival (CSS) and progression-free survival (PFS) probabilities were 46%, 48% and 23%, respectively, among patients who received antihistamines, and 23%, 32% and 13% for those who did not.

After excluding patients who experienced immune-oncology-related side effects, researchers found a 22% reduction in the risk of cancer-specific death and a 29% reduction in the risk of death from any cause.

The median follow-up time for patients receiving antihistamines was 17.7 months and 7.7 months for patients who did not receive them.

“In this study we investigated the impact of antihistamines on oncological outcomes among patients with [metastatic urothelial carcinoma] treated with second-line [Tecentriq] in two randomized clinical trials. We found that patients [who] received antihistamines concomitant to [immune-oncology] had longer OS, CSS and PFS relative to individuals who did not receive antihistamine medications,” wrote Dr. Giuseppe Fallara and colleagues in the study.

Fallara is a urologist in the Department of Urology at the IRCCS European Institute of Oncology in Milan, Italy.

Among patients who received antihistamines, the median OS was 17.7 months versus 8.1 months for those who did not. Likewise, the median PFS times were 4.9 and 2.3 months, respectively, and the CSS times were 22.8 and 9.3 months, respectively.

Patients with locally advanced UC or mUC generally face poor prognoses, with a five-year OS rate of approximately 6%, the researchers stated.

However, they noted that previous data suggest that antihistamines may improve cancer outcomes, particularly when administered in conjunction with immunotherapy, by reversing T cell dysfunction.

Tecentriq, a type of immunotherapy known as an immune checkpoint inhibitor, binds to the protein PD-L1 on the surface of some cancer cells, which prevents cancer cells from suppressing the immune system, according to the National Cancer Institute.

Of the 896 patients whose data were utilized in the study, 155, or 17%, used antihistamines during the two trials in question. Researchers reported that overall, 645 patients died of cancer-related causes and 59 died of other causes. Seven hundred patients experienced disease progression while on treatment.

Fallara and his colleagues acknowledged that their study had several limitations, including that researchers did not have detailed data regarding the timing, duration, type of antihistamine and reasons for antihistamine use.

“In conclusion, using individual patient data from the IMvigor210 and 211 trials, we found that concomitant use of antihistamines was associated with prolonged progression-free, cancer-specific and overall survival in patients treated with [Tecentriq],” Fallara and colleagues wrote. “Our results showed a positive association between antihistamine use and oncologic outcomes in patients with mUC treated with [immunotherapy]. This effect deserves further prospective investigation, ideally with a randomized controlled trial of antihistamine versus no antihistamine use.”

Research indicates that antihistamines may enhance progression-free and survival outcomes in metastatic urothelial carcinoma (mUC) patients treated with Tecentriq (atezolizumab). Data from the IMvigor210 and IMvigor211 trials showed improved overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) in patients using antihistamines. The study found a significant reduction in cancer-specific and all-cause mortality risks among these patients. Despite limitations, the findings suggest a potential benefit of antihistamines in conjunction with immunotherapy, warranting further investigation.

Antihistamines may be associated with survival improvement in patients with metastatic urothelial carcinoma receiving Tecentriq.

Additive Antihistamines May Improve Metastatic Bladder Cancer Outcomes

A powerful new ally is emerging in cancer care: artificial intelligence (AI). In the ever-evolving landscape of prostate cancer care, experts believe AI is rapidly becoming an integral part of the prostate cancer journey, offering innovative solutions from diagnosis to treatment planning.

This issue of CURE offers an insightful look into AI’s exciting potential, as explained by leading experts in the field. From the initial stages of detection to the complexities of treatment planning and beyond, AI is showing remarkable promise in augmenting clinicians’ capabilities.

“AI is definitely being folded into different levels of the entire journey for patients,” Dr. Soroush Rais-Bahrami, of Wake Forest University School of Medicine in Winston-Salem, North Carolina, says in our cover story.

For example, a UCLA-led study demonstrated AI’s ability to accurately predict seminal vesicle invasion, which is a crucial factor in determining the aggressiveness of a patient’s disease, guiding treatment decisions. Further, AI is making inroads into the realm of treatment itself, from enhancing the precision of robotic surgery to guiding targeted therapies like transurethral ultrasound ablation.
Although challenges around data privacy and the integration of AI into clinical workflows remain, our experts appear optimistic that AI will usher in a new era of personalized and effective prostate cancer care.

“Understanding each clinical case and personalizing treatment algorithms, decision-making [and] patient counseling is going to be key, and that’s where the nuances of AI will most likely normalize some of the personalization that was largely based on clinician and provider expertise,” Rais-Bahrami adds.

Also in this issue, we highlight results from a trial designed to evaluate personalized therapeutic vaccines among patients with kidney cancer, of which nine had successful anticancer immune responses and were cancer free approximately three years later. As part of CURE's “Speaking Out” video series, Dr. David Braun, from Yale School of Medicine in New Haven, Connecticut, spoke of the trial, its findings and where the field is headed next.

In addition, we offer insight from Dr. Chandler Park, of Norton Cancer Institute in Louisville, Kentucky, on a Food and Drug Administration (FDA) approval for adult patients with muscle-invasive bladder cancer. In particular, he highlights the use of neoadjuvant and adjuvant therapies, as well as what patients should discuss with their providers in the perioperative setting.

For the very latest news in cancer care, be sure to visit us at curetoday.com. We’re committed to bringing you timely updates, including breaking news on FDA approvals, clear explanations of significant cancer developments and much more.

Our mission is to equip you with the knowledge you need to confidently navigate your cancer journey. Within these pages, you’ll discover personal experiences alongside expert perspectives. As always, we hope you find this information both empowering and inspiring. Thank you for being a part of our community.

Artificial intelligence (AI) is becoming a crucial component in prostate cancer care, enhancing capabilities from diagnosis to treatment planning. AI's potential is demonstrated in studies like UCLA's, which showed AI's accuracy in predicting seminal vesicle invasion, influencing treatment decisions. Despite challenges in data privacy and clinical integration, experts are optimistic about AI's role in personalized cancer care. Additionally, the issue covers a trial on personalized therapeutic vaccines for kidney cancer and FDA approval insights for muscle-invasive bladder cancer, emphasizing the importance of personalized treatment and patient-provider discussions.

A powerful new ally is emerging in cancer care: artificial intelligence.

CURE Genitourinary Cancers Issue

Rapid Developments to Enhance Patient Experience in GU Cancer

Additive Antihistamines May Improve Metastatic Bladder Cancer Outcomes

The Dawn of AI in Prostate Cancer Care

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