ESMO 2021 again provided a variety of innovations in the management of genitourinary cancers. In prostate cancer (PCa), results of STAMPEDE suggest that early intensification of adjuvant therapy with ADT and abiraterone could become a new standard in high-risk non-metastatic PCa (currently off-label). Studies in metastatic castration-resistant PCa (mCRPC) indicated promising activity of 77Lu-PSMA-617 plus pembrolizumab and of cabozantinib plus atezolizumab. In the field of kidney cancer, patient-reported outcome data of KEYNOTE-564 further support adjuvant pembrolizumab as a new standard of care. Other studies in renal cell cancer (RCC) showed that treatment breaks during tyrosine kinase inhibitor therapy may be highly cost-effective without an effect on patient survival, that antibiotics can severely compromise survival outcomes in nivolumab-treated metastatic RCC patients and that therapeutic targeting of HIF-2α and VEGF may be effective in patients with metastatic clear cell RCC. In addition, cabozantinib proved to be safe and effective in patients with metastatic collecting ducts carcinoma. In urothelial cancer, dose-dense MVAC was identified as a safe and effective neoadjuvant treatment option for patients with muscle-invasive bladder cancer (MIBC). In metastatic urothelial cancer the addition of cetrelimab to erdafitinib seemed to increase treatment effects, while the EphrinB2-blocking agent sEphB4-HAS was found to have synergistic activity with pembrolizumab. Finally, an exploratory analysis of the pivotal IMvigor 130 trial found that cisplatin but not carboplatin seems to enhance anti-tumour immunity.

(BELG J MED ONCOL 2021;15(8):398–405)