David Morris’s tweet nicely captured a great talk from Maha Hussain on the rapidly evolving advanced prostate cancer space.

AI is more than just a catch phrase. Dr. Giovanni Cacciamani and Dr Neal Patel lead a break out session on how AI can empower urologists in their practice at this year’s LUGPA meeting.

The Kidney Cancer foundation provides a wonderful synopsis of the developments in kidney cancer treatment that happened at this year’s ESMO meeting. The authors note that there was data on novel first-line treatment approaches, though these haven’t come to western markets yet.

To give you another perspective and another format (podcast this time) on the highlights of ESMO 2023, I’d invite you to check out the Uromigos podcast as they’re joined by Silke Gillessen.

There has been considerable change in the treatment landscape for patients with advanced kidney cancer in the past 5 years. Doublet treatments, either IO-TKI or dual IO, are now standard of care and commonly used. While the benefits of this dual mechanism of action as combination therapy are impressive, it leaves questions regarding treatment choice at the time of progression. The LITESPARK-005 trial investigated whether the novel HIF-2A inhibitor belzutifan would improve outcomes compared to everolimus in this group of patients who had already received both immunotherapy and anti-angiogenic agents. Presenting these data, Dr. Toni Choueiri noted that patients who received belzutifan were significantly less likely to have disease progression and more likely to have disease response.

Combination therapy, either with IO-TKI or IO doublet, has become standard of care as first-line systemic therapy for advanced kidney cancer for a number of years now. However, thus far, in the second line setting, single agent therapy has typically prevailed. As presented by Dr. Toni Choueiri at ESMO 2023, the phase 2 LITESPARK-003 trial assessed the combination of cabozantinib with belzutifan in either patients who had not received prior systemic therapy (cohort 1) or those who had received prior immunotherapy (cohort 2). In both cases, we saw promising results.

Finally, I want to close you off with perhaps a different way of thinking about evolving treatment for our patients – while routinely look to intensify therapy, we rarely consider the importance of de-intensification. In the case of systemic therapy for kidney cancer, the combination of IO and TKI can carry significant toxicity. The TIDE-A study looked at intermitted axitinib with avelumab finding that this approach was safe oncologically for select patients while decreasing toxicity. I think, conceptually, this is an important paradigm for us to be considering.