Mechanistic Insights on Localized to Metastatic Prostate Cancer Transition and Therapeutic Opportunities

Prostate cancer is the most common non-cutaneous cancer among American men. Multiple mechanisms are involved in tumorigenesis and progression to metastases. While androgen deprivation therapy remains the cornerstone of treatment, progression to castration-resistant disease becomes inevitable. Aberrant pathway activations of PI3K/AKT due to PTEN loss, epithelial-mesenchymal transition pathways, homologous recombination repair, and DNA repair pathway mechanisms of resistance and cross-talk lead to opportunities for therapeutic targeting in metastatic castration-resistant prostate cancer. This review focuses on mechanisms of progression and key trials that evaluate the drugs and combinations that exploit these pathways.

Evolving Treatment Options for Metastatic Renal Cell Carcinoma (mRCC)

Approximately a third of patients diagnosed with kidney cancer in the United States present with advanced disease and those who present with distant metastases historically had dismal 5-year relative survival. However, over the last several years, advancements have led to improved life expectancy and patient outcomes in those who develop advanced renal cell carcinoma. Metastatic clear cell renal cell carcinoma (mccRCC) treatment has rapidly evolved with multiple drug approvals since 2006. Moreover, multiple combination regimens including a vascular endothelial growth factor tyrosine kinase inhibitor (VEGF-TKI) plus immune checkpoint inhibitor (ICI) and the combination of ipilimumab plus nivolumab have supplanted first-line VEGF-TKI monotherapy. Thus, the insights we gained from prospective randomized controlled trials focusing on systemic therapy beyond first-line therapy in mRCC patients treated in the TKI monotherapy era quickly became less relevant with the adoption of contemporary first-line combination regimens. Herein, we will review contemporary first- and second-line therapies for mccRCC, as well as highly anticipated clinical trials looking into novel regimens beyond first-line therapy in patients who have received combination therapy.

The role of switch maintenance therapy in urothelial cancers

Maintenance therapy with immune checkpoint inhibitors (ICIs) has changed the treatment paradigm of metastatic urothelial carcinoma (mUC). The JAVELIN Bladder 100 trial established avelumab, one of several ICIs in use today, as a life-prolonging maintenance therapy for patients with advanced urothelial carcinoma. Platinum-based chemotherapy is most often used in the first-line treatment of mUC, and while response rates approach about 50%, disease control is usually short-lived upon completion of the standard three to six cycles of chemotherapy. Much progress has been made in recent years in the second-line space and beyond with the use of ICIs, antibody-drug conjugates (ADCs), and tyrosine kinase inhibitors (TKIs) in eligible patients at the time of disease progression post-platinum-based chemotherapy. However, many patients with progressive mUC after first-line chemotherapy suffer from rapid progression of disease, treatment toxicity with subsequent lines of therapy, and a limited life expectancy. Until the results of the JAVELIN Bladder 100 trial were presented in 2020, there were no maintenance strategies proven to be beneficial over best supportive care after disease control is achieved with first-line platinum-based chemotherapy. To date, standard of care frontline treatment of metastatic urothelial cancer remains to be four to six cycles of platinum-based chemotherapy followed by maintenance avelumab. This review summarizes the current evidence available on maintenance therapies in mUC, as well as several highly anticipated clinical trials that we hope will result in further progress in the management of this aggressive cancer and improve patient outcomes.

A Contemporary Review of Immune Checkpoint Inhibitors in Advanced Clear Cell Renal Cell Carcinoma

The use of checkpoint inhibitors in advanced and metastatic renal cell carcinomas (RCCs) has rapidly evolved over the past several years. While immune-oncology (IO) drug therapy has been successful at resulting in improved responses and survival, combination therapies with immune checkpoint inhibitors and vascular endothelial growth factor (VEGF) inhibitors have further improved outcomes. This article reviews the landmark trials that have led to the approval of IO therapies, including the Checkmate 214 trial and combination IO/VEGF TKI therapies with Checkmate 9ER, CLEAR, and Keynote-426, and it includes a discussion on promising therapies moving in the future.

The complete mitochondrial genome of Ancherythroculter kurematsui (Cypriniformes: Cyprinidae)

Ancherythroculter kurematsui (A. kurematsui) is a unique small-size freshwater fish in southwest China. In this study, the complete mitochondrial genome of A. kurematsui was determined (GenBank accession number is KU234534). The mitochondrial genome sequence of A. kurematsui was a circular molecule with 16,621 bp in length, and contained 37 typical animal mitochondrial genes including 2 ribosomal RNA genes, 13 protein-coding genes, 22 transfer RNA genes and a control region (D-loop). Four nucleotide compositions and their relative proportions of the entire mitogenome was 27.69% C, 16.16% G, 31.21% A and 24.93% T, with an A + T and G + C contents being 56.14% and 43.86%, respectively.

Angiogenesis inhibitors in prostate cancer therapy

Limited treatment options exist for metastatic castrate-resistant prostate cancer (mCRPC). The concept of targeting tumors via anti-angiogenic mechanisms has been studied over the last decade, giving rise to a new class of anti-cancer drugs. Currently, the use of angiogenesis inhibition in prostate cancer is the focus of many ongoing clinical trials, with tumor progression and overall survival established as outcome measures. Several anti-angiogenic agents are currently under investigation with varying mechanisms by which they exert activity against prostate tumors. We describe the significant findings and outcomes of clinical trials involving the use of these drugs in mCRPC patients, along with how these results will translate to their use in the clinical setting. Open interventional trials that are currently recruiting participants are also mentioned. While the use of angiogenesis inhibition holds promise in the treatment of prostate cancer, several challenges still exist. The foreseeable clinical implications and limitations of anti-angiogenic therapy and the potential use of biomarkers are hereby discussed.