#ASCO20 Virtual Scientific Program: Dr. Neeraj Agarwal Discusses Key Abstracts in the GU Field

In today’s episode, we hear from Dr. Neeraj Agarwal, associate editor of the ASCO Daily News and director of the Genitourinary Oncology Program at the University of Utah’s Huntsman Cancer Institute, about key abstracts and remarkable new developments in the GU field featured during the #ASCO20 Virtual Scientific Program.

Transcript

ASCO Daily News: Welcome to the ASCO Daily News podcast. I'm Geraldine Carroll, a reporter for the ASCO Daily News. I'm delighted to welcome Dr. Neeraj Agarwal to the podcast today. Dr. Agarwal is Associate Editor of the ASCO Daily News and directs the Genitourinary Oncology Program at the Huntsman Cancer Institute at the University of Utah where he also serves as Professor of Medicine.

Dr. Agarwal joins us to discuss abstracts and some remarkable new developments in the GU field featured during the ASCO20 Virtual Scientific Program. Dr. Agarwal reports paid consulting on the scientific advisory boards of AstraZeneca, EMD Serono, Pfizer, Janssen, Bayer, Exelixis, Genentech. And full disclosures relating to all Daily News podcasts can be found on the episode pages. Dr. Agarwal, welcome to the ASCO Daily News podcast.

Dr. Neeraj Agarwal: It's a pleasure. Thanks for having me.

ASCO Daily News: Dr. Agarwal, can you tell us about the abstracts in the GU field that you're really excited about this year?

Dr. Neeraj Agarwal: Of course. I would like to encourage the listeners to visit abstract LBA1 on the JAVELIN 100 trial, which was presented by Dr. Tom Powles on the efficacy of avelumab in patients with metastatic urothelial carcinoma as a front-line maintenance therapy. In this remarkable study, 700 patients were enrolled in a phase III randomized control trial after they had completed chemotherapy, the standard chemotherapy for a new diagnosis of metastatic urothelial carcinoma or metastatic bladder cancer.

So, just to take a step back, currently, the standard of care for patients who are diagnosed with metastatic urothelial carcinoma is chemotherapy with cisplatin or, those patients who are not eligible for cisplatin, chemotherapy with carboplatin-based regimens. The median survival is approximately 18 months with cisplatin-based chemotherapy regimens and lower with carboplatin-based regimens.

And, at this point of time, we wait for these patients to experience disease progression, which is universal, pretty much, in these patients. And, when they have disease progression, they are treated with immune checkpoint inhibitors. And five of them are currently approved in this setting.

So what was novel about this study presented by Dr. Tom Powles and senior co-authored by Dr. Petros Grivas is that they utilized ab immune checkpoint inhibitor, avelumab, which is already approved for patients who are experiencing disease progression. So, instead of waiting for disease progression, the patients were randomized to receive standard of care, which is observation, versus treatment with avelumab. So this entirely new concept is called as front-line maintenance therapy.

So 700 patients who had completed four to six cycles of chemotherapy for their metastatic urothelial carcinoma were randomized to standard of care, which is observation with scans every three months, versus treatment with avelumab right after completion of their chemotherapy. The primary endpoint was overall survival.

And it was striking to see the improvement in overall survival. The patients who received avelumab, the median overall survival was 21.4 month versus 14.3 months in patients who did not receive avelumab. The hazard ratio for overall survival benefit was 0.69, which basically translates into a 30% reduction in risk of death in patients who receive avelumab therapy.

It was remarkable to see that overall survival was significantly improved in patients who received treatment with avelumab. The median overall survival was 21.4 months versus 14.3 months with a 30% reduction in risk of death in patients who received avelumab therapy. Even progression-free survival was also improved in patients who were receiving avelumab with approximately 40% reduction in risk of progression or death.

The side effects were expected, as to what you would see with avelumab therapy. And avelumab, as you know, is immune checkpoint inhibitor already approved in patients with metastatic urothelial carcinoma. And side effects seen were expected, and there were not new signals as far as safety was concerned.

With these results, there is no doubt that avelumab will be approved for our patients who are completing chemotherapy with carboplatin and cisplatin for metastatic urothelial carcinoma. And they will have the chance to receive avelumab up front in a front-line maintenance setting. And this is very gratifying to see these kind of results for our patients.

ASCO Daily News: Dr. Agarwal, there are several posters that show promising impr...