JSCO2016: International Session 4 Urological Cancer (Prostate and Renal Cancer)

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The 54th Annual Meeting of Japan Society of Clinical Oncology (JSCO2016)

"Renovation of Cancer Medicine in the Mature Society"



International Session 1: Lung Cancer
International Session 2: Colorectal Cancer
International Session 3: Gastric Cancer
International Session 4: Urological Cancer (Prostate and Renal Cancer)
International Session 5: Supportive Care for Adverse Events
International Session 6: Gynecological Cancer (Uterine Body Cancer and Ovarian Cancer)
International Session 7: Central Nervous System Tumor
International Session 8: New Development of Particle Beam Therapy for Cancer
International Session 9: International Cooperation in Radiation Medicine
International Session 10: Recent Advances In Cancer Immunotherapy
International Session 11: Breast Cancer
International Session 12: Pharmacology of Antitumor Agents: New Drug Application (NDA)
International Session 13: Malignant Lymphoma
International Session 14: Palliative Care
International Session 15: Radiation Therapy
International Session 16: Head and Neck Cancer
International Session 17: Skin Cancer (Malignant Melanoma)
International Session 18: Hepato-Biliary and Pancreas Cancers
International Session 19: Leukemia
International Session 20: Ethics for Clinical Research
International Session 21: Esophageal Cancer
International Session 22: Bone and Soft Tissue Tumor
FACO/JSCO Joint Symposium

Abstract Archives (in Japanese)


International Session 4: Urological Cancer (Prostate and Renal Cancer)


Clinical practice guideline for prostate cancer 2016 in Japan
Yoichi Arai (Department of Urology, Tohoku University Graduate School of Medicine)
Evidence-based Clinical Practice Guidelines for Prostate Cancer was first published by the Japanese Urological Association in 2006, which was revised in 2012. During the last decade, there has been a dramatic increase in prostate cancer cases in Japan. According to the 2015 Cancer Information Service of the National Cancer Center, prostate cancer was estimated to become a leading cancer in Japan and was expecting 98,000 new cases. Remarkable advances have been made in medical practice in relation to prostate cancer and a large amount of new evidence has been accumulated.
The JUA is jus preparing an updated 2016 version, which includes epidemiology, chemoprevention, screening, diagnosis (biomarker, imaging and biopsy), staging/risk classification/nomogram, pathological issues, active surveillance, radical prostatectomy, external radiation therapy, brachytherapy, focal therapy, salvage therapy, androgen deprivation therapy, new therapeutic agents for castration-resistant prostate cancer, bone targeted therapy (bone health) and palliative therapy. The Guidelines Panel consists of a group of Japanese urologists, radiation oncologists, radiologists, and pathologists.
This guideline presents clinical practice methods that are thought to be the most standard methods in Japan at the present time and assist medical professionals assess the evidence-based management of prostate cancer. The updated guideline will be briefly summarized in the session.


Year in review from US: Prostate cancer
Anthony L. Zietman (Department of Radiation Oncology, Massachusetts General Hospital, USA)
In this talk I will give a personal perspective on prostate cancer, and summarize the studies that have had the most profound effect on either our thinking, or our practice, over the last two years. ProtecT is a huge British randomized trial that looks at PSA screening but in addition has randomized nearly 2000 men with early prostate cancer to either surgery, external radiation, or active monitoring. The results of this latter randomization will be published before the JSCO meeting and their implications will be discussed. An issue that has challenged oncologists for three decades will finally be answered.
Threede RCTs have been published looking at abbreviated, hypo-fractionated, radiation regimens. All reached the same conclusion, in this era of image-guided and accurate therapy shorter, cheaper, and more convenient, fractionation schedules are as effective as longer schedules and have the same safety profile.
The surgeons continue to debate the use of robotic technology for their prostatectomies compared with traditional open surgery. Despite the passion expressed, the latest randomized data suggests no difference in outcome.
Following prostatectomy, patients frequently have PSA recurrence and are managed with salvage radiation. Two new randomized trials suggest that the addition of androgen deprivation to the radiation can improve outcomes further.
STAMPEDE is a unique new platform for progressive randomized trials developed in the UK. It is being used to sequentially evaluate a number of new agents in locally advanced and metastatic disease and is a major mechanism by which we be gaining new information in the future. The findings so far will be discussed as well as what we can expect in the near future.


ESMO guidelines and progress in renal cell cancer
Alan Horwich (Clinical Oncology, The Institute of Cancer Research, UK)
The ESMO renal cell cancer guideline was published in 2014 and is being updated this year. The statements are supported by the Level of Evidence (LOE), and the Strength of Recommendation (SOR). LOE indicates the quality of research, SOR indicates whether the intervention should be used or avoided. For newly-licensed drugs we now report the Magnitude of Clinical Benefit Scale (MCBS). Important recent clinical evidence is reported on second-line treatment in those previously treated with a tyrosine-kinase inhibitor. Nivolumab, a PD1 (Programmed Death 1) checkpoint inhibitor was compared with everolimus in a randomised trial in 821 patients with advanced renal cancer. The median overall survival was longer with nivolumab, at 25.0 months versus 19.6 months (HR 0.73). There was a higher response rate, and fewer grade 3/4 adverse events. Nivolumab will be recommended with LOE I, SOR A and MCBS V. A trial of cabozantinib versus everolimus was in 658 patients who had failed a TKI.It prolonged PFS, 7.4 versus 3.8 months (HR 0.58) and the response rate was higher at 21% versus 5%. However cobozantinib had more adverse events (hypertension, diarrhea, fatigue, paslmar-plantar syndrome) leading to dose reduction in 60% and drug cessation in 9%. Cabozantinib will also be a recommended second-line treatment.


Year in review from Japan: Renal cell carcinoma
Hideaki Miyake (Urology, Faculty of Medicine, Hamamatsu University School of Medicine)
In this year, the trend of treatment for renal cell carcinoma (RCC) has appeared to be markedly changing in the fields of both surgical and systemic therapies in Japan. One topic is the insurance coverage of robot-assisted partial nephrectomy (RAPN) in this April; thus, the current status of RAPN as a treatment for small renal mass in Japan will be initially summarized. Furthermore, the preliminary outcomes of RAPN at our institution will be subsequently presented, focusing on our technical approaches associated with this procedure, such as real-time 3D image overlay navigation system and selective arterial clamping. Another topic is the introduction of nivolumab, an immune checkpoint inhibitor antibody that selectively blocks the interaction between PD-1 and its ligands PD-L1 and PD-L2, into Japanese clinical practice as one of the second-line agents for treatment of metastatic RCC. To date, however, several types of molecular-targeted agent, showing powerful activities against metastatic RCC, have been widely used in Japan and contributed to markedly improve the prognosis of metastatic RCC patients; accordingly, the application of nivolumab should be carefully determined considering the wide variety of clinical features of this agent, including its extremely expensive price. Taken together, we would like to present our data regarding second-line targeted agents in relation to the therapeutic efficacy and tolerability in Japanese metastatic RCC patients, and the suitable strategy for sequential treatment for metastatic RCC in Japan will be discussed based on our experience. Finally, by presenting some more interesting small subjects associated with RCC in addition to two main topics described above, current aspects of treatment for RCC in Japan will be overviewed in this lecture.


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