Metastatic renal cell carcinoma should be managed with immune-oncological therapy. In patients with good prognosis, the combination of pembroluzimab and axitinib or avelumab and axitinib has resulted in a significant benefit as compared to sunitinib alone. In patients with intermediate of poor prognosis, the combination of ipilimumab and nivolumab has demonstrated superior oncological activities as compared to sunitinib, whereas no benefit was shown in patients with good prognosis.
Prospective single-arm phase-II trials have demonstrated superior response rates of muscle-invasive bladder cancer to neoadjuvant systemic therapy with pembrolizumab or azetolizumab in muscle-invasive bladder cancer. Ongoing prospective randomized clinical phase-III trials compare neoadjuvant chemotherapy and immune-oncological therapy versus chemotherapy alone.
In men with hnmPCA, the combination of ADT and apalutamide has demonstrated significant benefit in oncological outcome as compared to ADT alone. The benefit was independent on the metastatic burden so that the medication has been approved for the so called 'allcomers'. Moreover, abiraterone and docetaxel is a new kid on the block.
In mCRPC, a prospective phase-II crossover trial has demonstrated the oncological benefit of the sequence abiraterone followed by enzalutamide that should be the sequence of choice.
For men with clinical stage I high-risk nonseminomas relapsing after one cycle of PEB chemotherapy, it has been shown that relapse-free and OS rates are inferior as compared to a group of testis cancer patients with de-novo metastases.
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Curr Opin Urol. 2020;30(4):594-601. © 2020 Wolters Kluwer Health, Inc.