The Lank Center for Genitourinary Oncology at Dana-Farber Cancer Institute presents a succinct summary of all the genitourinary cancer clinical updates you need to know from ESMO 2022
if you're just joining us where you're presenting G. One ecology highlights from his mo 2022. Um I have dr Tiwari here who is going to finish up the session by presenting some brief updates on germ cell and testicular cancer. Great thank you for having me. I know this is why everyone stayed until the end. So I will make it worthwhile. Um a very small list of disclosures. So there was really only one presentation testicular cancer that I think is relevant to kind of ongoing clinical practice. I'll present one other study that just kind of gives you a sense about prognosis. But the study that was presented I think is worth keeping an eye on is the question of using retro paired well with node dissection for clinical stage two semin oma. And so as you'll know for the options for clinical for clinical stage two Semin Omar really a radiation or chemotherapy. But there's a lot of retrospective data and also now some emerging prospective data looking at whether um surgical management of this disease is a feasible option. And so on the bottom left is data from a retrospective study from tobacco and colleagues in 2020 that basically mind I think it was seared data or one of the large kind of claims databases to look at usage of R. P. L. And D. And Semin OMA. And they identified a little over 300 patients that had undergone Semin OMA and basically were able to show that there was indeed a long term survival a little worse for stage two A two B. Relative to stage one who underwent seven Oma. Sorry R. P. R. And D. But suggesting that you know it's you know patients do have long term favorable outcomes which may you know so which may suggest that seminar was not unreasonably managed by R. P. L. And D. On the top part of the side of the three prospective trials that are ongoing uh testing rpm. D. N. C. S. Two semi noma. And the presentation specifically was of the co trim study at as mo which is done by a german group and so the C. Is for cologne. Um and so this was a relatively small study. All the studies are not very large but of 23 patients with a median follow up of 25 months. And the relapse rate was similar to what was seen in the semis trial which is the us-based trial with a slightly larger patient population. And this is all you know two year relapse rates and so very early no no survival data which will take I think longer to develop. Um But certainly better outcomes than the other prospective study of smaller much smaller study. The prime test study. So when you're thinking about whether you want to use our P. L. And D. Or radiation or surgery since really you know we're thinking that survival is probably going to be rather good regardless you want to think about the side effects of your treatment. And so to this end from the coatroom study um they presented a bunch of their kind of outcome data beyond just the relapse rate. And so uh of those patients in the study the main hospital stay was 4.5 days to patients were done robotically. Four patients had basically this Cleveland indo scale three A or greater complications. And indo is the surgical kind of scale that basically says what kind of interventions are needed to fix the problems that arise after a procedure. And so three is basically some sort of surgical procedure. The surgeries were well done. Retrograde ejaculation was not seen in the majority of patients and what I think is maybe compelling and what has to be kind of confirmed in larger studies is that one patient who underwent R. P. L. And D. With station disease actually had embryonal carcinoma despite a Seminole primary. And so if they had picked radiation which you know we don't use all that commonly. But it's certainly a feasible option for Semin Oma that that patient would have been treated incorrectly. And finally the thing I think although also worth mentioning is that 20% of patients on the coach from study had benign findings at R. P. L. And D. Including one of the patients who was clinically Stage two. And so there is not an insignificant false positive rate with ct scans for patients with Stage one or stage two disease. So something to always keep in mind. So I think this is an emerging area. Um I think hopefully as we get more experience with it and the prospective setting will really start to know if this is very feasible. Certainly in my practice I've had one or two patients go for R. P. L. N. D. And I know some of our other colleagues have had more. Um and you know it's gone okay so far and so but I think we need the prospective data to really see. The other study I want to present is a study of wondering whether de novo metastatic testicular cancer is worse prognostic lee than relapsed clinical Stage one disease. And the short answer is no it is not really. The basically the this was a presentation by the I. G. C. C. C. G. Group. And in the interest of time I'm basically just going to show the right sided or focus on the right side of Kaplan Meier plot which shows that um even though de novo metastatic patients overall seem to have slightly worse outcomes when you stratified by I. G. C. C. C. G. Risk group. That difference goes away. And so the the answer is no. Um so the key is to detect your relapses as early as possible with appropriate surveillance and manage per per per standard of care. And so that's uh that's all I'm gonna say outstanding. Um dr Sweeney I know you're still here. I'll give you an opportunity if if you have any comments that you want to make about any of this data otherwise we can wrap up. Testis cancer is hard. It involves a lot of thought and patient specification data is still emerging on which way to go. Look. I had an interchange with Darin Feldman and Larry Einhorn and they too are getting more intrigued but very cautiously and early days with the role of clinical um R. P. R. N. D. By experts for clinical stage 27. Oma recognizing what you pointed out that none of those patients don't have disease at relapse. So I think that's probably the one emerging data point that we should keep a close eye on us too. Which may change practice. So there are studies enrolling as you pointed out and I think that's the one thing we need to think about and maybe get it start thinking about it with our surgeons and how we get a part of that. Great well with that we will wrap up thank you so much to all the presenters and discussing and thank you to everyone for joining us. We will look forward to seeing you at the Asco G. U. 2023 meeting recap in a few months. Everyone have a great night. Yeah
