Genomic Testing

Rohan Garje, MD, discusses precision medicine in metastatic prostate cancer, including genomic testing, targeted therapies, and theragnostics.

"[This] shows a different approach for detecting circulating tumor DNA in bladder cancer patients, and it opens up the possibility for other biorepositories that have serum samples to also enter the ctDNA research environment," says Richard T. Bryan, MBChB, PhD, MRCS, FacadTM.

"This preplanned ENACT trial biomarker analysis demonstrates the value of the Decipher score, AR-A score, and PAM50 genomic classifiers in identifying patients undergoing AS who are most likely to benefit from enzalutamide treatment," wrote the authors.

"I think the greatest implication the study has is that it tells us that family history and germline genetics independently provide complementary information that's important for risk stratification of localized prostate cancer," says Keyan Salari, MD, PhD.

The MPS2 models demonstrated negative predictive values of 95% to 99% for cancers of grade group 2 or higher and of 99% for cancers of grade group 3 or higher.

"What we found is that over a third of patients, 36%, had positive family history of either prostate, breast, or pancreatic cancer. And if you had this type of a family history, there was nearly a two-fold risk of dying of prostate cancer in the long term," says Keyan Salari, MD, PhD.

"As a kidney cancer community, we need to investigate these molecular subtypes prospectively in clinical trials to determine whether specific subtypes benefit from certain therapies or not," says David A. Braun, MD, PhD.

The study is exploring the small activating RNA therapy RAG-01 in patients with BCG-unresponsive non–muscle-invasive bladder cancer.

“Systemic therapy for RCC has changed very quickly. Every year, it's exciting to see that we're getting new developments, new drug approvals, and changes in the standard of care,” says Wenxin (Vincent) Xu, MD.

Rohan Garje, MD, discusses recent research linking TP53, RB1, and PTEN mutations with worse overall survival outcomes in prostate cancer.

“The MODERN trial represents a step towards precision medicine in bladder cancer treatment," says Matthew D. Galsky, MD.

The novel agent ABSK061 approached a response rate of 40% in patients with advanced solid tumors harboring FGFR2/3 alterations.

The AssureMDx test demonstrated an area under the curve of 0.80 in detecting urinary tract recurrences in MIBC.

“So, my take home message for the urology community is even if you're not doing clinical trials, we already have FDA-approved, CMS-covered, most commercial insurances-covered genetic alterations now for our CRPC populations, and there will be more to come,” says Neal D. Shore, MD, FACS.

"Our studies consistently demonstrated that data from the Decipher Prostate Genomic Classifier was more reliably predictive of prostate cancer progression and underlying pathology than any other clinical data available, including MRI," says Eric Kim, MD.

Correlation found between the biomarker HSD3B1 and resistance to combined hormone therapy and radiotherapy

"The genomics assay was using biopsy tissue to help patients make decisions for the treatment choices. We also tested the effect of the assay on provider choice," says Adam B. Murphy, MD, MBA, MSCI.

“Our analysis suggests that there is superior clinical benefit with olaparib versus control both in patients who had and had not received previous taxane treatment,” said Maha Hussain, MD, Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

"Then [we] also started looking at somatic testing, because if you only stop at germline testing, you miss another 50% of patients who would have somatic alterations who have resistant prostate cancer," says Neal D. Shore, MD, FACS.

"In these studies, we were pleased to find that disitamab vedotin has consistent efficacy and manageable safety in patients with chemotherapy-refractory mUC," says Jun Guo, MD.

A recently published study found an association between PARP inhibitor treatment and an increased risk of hematological adverse events, including anemia, thrombocytopenia, and neutropenia, in patients with metastatic castration-resistant prostate cancer.

On an episode of Cleveland Clinic’s Cancer Advances podcast, host Dale Shepard, MD, PhD, talks with Omar Mian, MD, PhD, about emerging molecular biomarkers for genitourinary cancers.

According to the survey, 79% of Black men know that genetic information can help improve prostate cancer outcomes, yet 33% indicated that they would be unwilling or uncertain to provide DNA samples, even if it meant finding new treatment options.

Circulating tumor DNA is showing promise as a tool to guide decisions on treatment intensification and de-escalation in patients with renal cell carcinoma.

Translocation renal cell carcinoma is a rare type of RCC that is typically characterized by gene fusions involving the MiT family of transcription factors including TFE3, TFEB, TFEC, and MiTF.

Notably, the study represents a 57% increase in the number of non-European participants compared with previous prostate cancer genome-wide association studies.

"For those people in the intervention arm who did get the assay, the doctors were more likely to prefer active treatment with surgery or radiation compared to the control group," says Adam B. Murphy, MD, MBA, MSCI.

"All of our tools, including genomics and MRI, enable us to do a better job of risk stratifying [patients] to have a more appropriate shared decision-making discussion [about active surveillance]," explains David Morris, MD.

"ctDNA holds a unique position as it offers a molecular means to quantify the extent of residual disease burden," says Adanma Ayanambakkam, MD.