HOW I DO IT

• How I Do It: Maintenance avelumab for advanced urothelial carcinoma

  Lalani A. Aly-Khan Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada

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  For more than four decades, platinum-based chemotherapy regimens have served as the established standard-of-care for advanced urothelial carcinoma (aUC). However, advancements in our understanding of cancer biology and tumor microenvironment have reshaped the therapeutic landscape and prognosis of this incurable disease. Immune checkpoint inhibitors (ICIs) that target programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1) are firmly established tools in aUC management, leading to enhanced life span and improved quality of life for patients. In patients who achieved stable disease or better following platinum-based chemotherapy, maintenance therapy with the PD-L1 antibody avelumab significantly enhanced overall survival (OS) by approximately 7 months compared to best supportive care in the phase 3 JAVELIN Bladder 100 trial. As a result, avelumab received FDA approval in June 2020 as a maintenance therapy for aUC patients treated with first-line platinum-based chemotherapy. Therefore, aUC care plans should incorporate maintenance avelumab into standard first-line treatment regimens for these patients. The objective of this brief article is to provide insight into the utilization of avelumab, identify patients who may benefit from this treatment, and review the methodology, advantages, potential side effects and their management.

  Keywords: bladder cancer, avelumab, advanced urothelial carcinoma, metastatic, immune checkpoint inhibitor,

  Aug 2023 (Vol. 30, Issue 4 , Page 11633)
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• Using darolutamide in advanced prostate cancer: How I Do It

  Hamilton Joelle, MD Urology Centers of Alabama, Homewood, Alabama, USA

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  Darolutamide is a nonsteroidal androgen inhibitor FDA approved for the treatment of castration-resistant non-metastatic prostate cancer (nmCRPC). After decades of offering androgen deprivation therapy (ADT) alone or first-generation androgen receptor blockers for patients whose PSA was rising despite castrate levels of testosterone, there are now three different treatment options to add to ADT. These include apalutamide approved in February 2018, enzalutamide FDA approved in June 2018, and darolutamide approved July 2019. Each of these androgen receptor pathway blockers, when added to ADT or surgical orchiectomy, prolongs metastasis-free-survival (MFS) and median survival (MS). This paper focuses on the use of the newest approved agent in this class, darololutmide.

  Keywords: prostate cancer, castrate-resistant, non-metastatic disease, antiandrogen, darolutamide,

  Jun 2021 (Vol. 28, Issue 3 , Page 10673)
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• How I do it: Apalutamide use in non-metastatic castrate resistant prostate cancer

  Moul W. Judd, MD Division of Urology, Department of Surgery and Duke Cancer Institute, Durham, North Carolina, USA

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  Urologists have been using oral nonsteroidal antiandrogens (AA) for 30 years as a component of combined androgen blockade. In February 2018, a new third generation AA, apalutamide, became available for the first time for non-metastatic (M0) castrate resistant prostate cancer (CRPC). Apalutamide was found to delay the presence of metastases (metastases free survival-MFS) by approximately 2 years versus placebo in M0 CRPC. While overall survival benefit has yet to be established, the MFS benefit is clinically meaningful and urology practices should be equipped to manage patients using this new oral agent. Since the majority of patients remain under urologic care when this disease stage develops and because the drug is straightforward to administer, urology practices are ideal to identify and treat. The objective of this brief article is to discuss the typical patient profile for use of apalutamide and to review the pros and cons of use and common side effects and management.

  Keywords: prostate cancer, apalutamide, castrate-resistant, non-metastatic disease, antiandrogen,

  Jun 2019 (Vol. 26, Issue 3 , Page 9782)
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