Among the most eagerly awaited data from this year’s ESMO meeting was presented in the Presidential session on Monday morning by Oliver Sartor. The initial results of the PSMAfore study showed that, in patients with mCRPC who had progressed on one androgen receptor signaling inhibitor but had not yet received chemotherapy, the use of Lu-PSMA was associated with significant improvement in radiographic progression free survival compared to a switch in ARSI. However, as of this presentation, a survival benefit has yet to be demonstrated. This may be in part due to data immaturity or due to crossover. However, it’s worth noting that the control arm (ARSI switch) is clearly substandard for patients who are chemotherapy-eligible.

While we’ve seen a lot of data regarding the combination of ARSIs and PARP inhibitors over the last year or two, this year’s ESMO meeting provided interesting data on a novel combination – that of enzalutamide with Lu-PSMA. Dr. Louise Emmett presented results of the phase 2 ENZA-p study demonstrating a significant improvement in PSA-progression free survival for patients receiving the combination approach. This is the first study looking at such a combination – one that will be assessed in numerous coming studies.

For years, adjuvant radiotherapy was recommended for patients with adverse pathological fundings at the time of radical prostatectomy. However, in 2020, a number of trials were published demonstrating no benefit to adjuvant radiotherapy compared to an early salvage strategy. The largest of these was the RADICALS-RT trial. At this year’s ESMO, Dr. Noel Clarke presented final results of this trial. Again, he emphasized that an adjuvant therapy approach did not improve important clinical endpoints but did increase side effects. These are important data for urologists and emphasize early salvage radiotherapy as the standard of care following radical prostatectomy.

Signing off this email, I was to highlight one of the key speakers for this year’s event. On Friday morning, Ross Bernstein will be giving a talk entitled The Champion’s Code. He will present his keynote talk on optimizing performance, based on experience and examples drawn from the world of sports – hall of fame athletes and championship teams.