Dr XY Jiang

This is the treatment algorithm we’ve used during our discussion with @bergsa83 and @JoshMeeks on #BladderCancer ✅ NMIBC ✅ MIBC ✅ Metastatic Disease #OncTwitter #MedX @OncUpdates @OncoAlert #gusm

TALAPRO-2 in simple terms 👇 Adding talazoparib to enzalutamide improves outcomes in mCRPC: 👉 OS: 45.8 vs 37 months 👉 HR 0.80 (ITT) So yes—the combination works. --- 🔥 But the key insight: Benefit is not equal across patients BRCA → major benefit (HR ~0.26) Non-BRCA HRR → moderate Non-HRR → modest 👉 Same treatment, different impact --- ⚠️ Trade-off G3 anemia ~50% 👉 Not a trivial addition --- 🧠 Clinical message This is not for everyone BRCA → strong candidate Others → selective use --- ⚡ Bottom line “PARPi + ARPI works—but biology decides how much.” #ProstateCancer #mCRPC #MVOnco

4 PARPi + ARPI trials in mCRPC—what do they show? 👇 BRCAAway → combo > sequence TALAPRO-2 → OS benefit (HR 0.80, ITT) MAGNITUDE → ❌ no benefit in HRR– PROpel → benefit not uniform --- 🔥 Key message 👉 BRCA drives the benefit 👉 Beyond that, gains become smaller --- ⚡ Bottom line “Same combo—but not for all. Biology decides.” --- #ProstateCancer #mCRPC #MVOnco

Are we still sequencing in HRR mCRPC? 🤔 BRCAAway (1L, ARPI-naïve, ~25% prior docetaxel mHSPC): Abi vs Ola vs Abi+Ola PFS: 8 → 14 → 39 mo OS: 28 → 37 → 68 mo Sequential ≈ 16 mo total 👉 BRCA2 ~75% → main driver ❓ BRCA1 (n=3) limited data ⚠️ ATM weaker ❌ Other HRR heterogeneous (exploratory PFS ~5 mo) 👉 All HRR ≠ equal 👉 Combination > Sequential Hit early. Hit together. #MVOnco #ProstateCancer #mCRPC #PrecisionOncology

9️⃣ Among cribriform+ cancers: ❌GG≥3 or pT3b: ⬆️ metastasis risk ✅GG2 pT2-T3a ➡️ very few metastatic

Among men with locally advanced prostate cancer, transdermal estradiol was noninferior to LHRH agonists for 3-year metastasis-free survival and led to a lower incidence of hot flashes but a higher incidence of gynecomastia. Full results of the STAMPEDE-1 and PATCH trials: nejm.org/doi/full/10.10…

Global pooled analysis of 8 RCTs including >3000 patients shows NO impact of time of day on the efficacy of ICIs. Which is consistent with the PK and MoA of these drugs. The outlier appears to be the LungTIME-C01 trial — for which a note of caution was posted on @NatureMedicine .

Kidney cancer care just got a major upgrade. The NICE 2026 guideline finally gives a full roadmap for RCC, from diagnosis → treatment → follow-up. ⚙️ What changes in clinic: 🔬 Biopsy matters more • Recommended for small renal masses (≤4 cm) when it impacts decisions 👀 Active surveillance is legit • Now standard option for selected small tumors + Bosniak 3 cysts 🔪 Surgery still leads • Remains gold standard for many localized cases 🔥 Non-surgical options • Ablation / SABR for patients unfit or unwilling for surgery 📊 Follow-up gets smarter • Risk-adapted imaging instead of one-size-fits-all 👨‍⚕️ Team-based care • Strong push for MDT + clinical nurse specialist access 💡 Takeaway 👉 Less overtreatment, more personalization, better structured RCC care 🔖 This will change real-world practice more than most trials. 📖 Full paper in comment ⬇️ #OncoTwitter #MedTwitter #KidneyCancer #RCC @OncoAlert @myesmo @esmo_open @asco

👉 High-risk prostate cancer isn’t truly “local” STAMPEDE shows adding Abiraterone: • ↓ Metastasis (~47%) • ↓ Death (~40%) 👉 Treat early. Treat stronger. 👉 Practice-changing #MVOnco #ProstateCancer #Oncology #MedEd

Steve Jobs gave a 15-minute speech at Stanford in 2005 that still changes lives today: "Today I want to tell you three stories from my life. That's it. No big deal. Just three stories." Story 1: Connecting the dots "I dropped out of Reed College after the first 6 months. I couldn't see the value in it. I had no idea what I wanted to do with my life, and here I was spending all of the money my parents had saved their entire life. So I decided to drop out and trust that it would all work out. It was pretty scary at the time, but looking back, it was one of the best decisions I ever made." Steve shares what happened next: "Because I had dropped out, I decided to take a calligraphy class. I learned about serif and sans-serif typefaces, about varying the space between letter combinations, about what makes great typography great. None of this had even a hope of any practical application in my life. But ten years later, when we were designing the first Macintosh, it all came back to me. It was the first computer with beautiful typography." He reflects: "You can't connect the dots looking forward. You can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something: your gut, destiny, life, karma, whatever. Believing that the dots will connect down the road will give you the confidence to follow your heart, even when it leads you off the well-worn path." Story 2: Love and loss "At 30, I got fired from Apple, the company I started. What had been the focus of my entire adult life was gone. It was devastating. I was a very public failure, and I even thought about running away from the valley." Steve explains what saved him: "But something slowly began to dawn on me, I still loved what I did. The turn of events at Apple had not changed that one bit. I had been rejected, but I was still in love. And so I decided to start over." He shares what came next: "Getting fired from Apple was the best thing that could have ever happened to me. The heaviness of being successful was replaced by the lightness of being a beginner again. During the next five years, I started NeXT, started Pixar, and fell in love with an amazing woman who would become my wife. I'm pretty sure none of this would have happened if I hadn't been fired from Apple." His advice: "Your work is going to fill a large part of your life. The only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do. If you haven't found it yet, keep looking. Don't settle." Story 3: Death "When I was 17, I read a quote: 'If you live each day as if it was your last, someday you'll most certainly be right.' Since then, for the past 33 years, I have looked in the mirror every morning and asked myself: 'If today were the last day of my life, would I want to do what I am about to do today?' And whenever the answer has been 'No' for too many days in a row, I know I need to change something." Steve shares why death is such a powerful tool: "Remembering that I'll be dead soon is the most important tool I've ever encountered to help me make the big choices in life. Almost everything, all external expectations, all pride, all fear of embarrassment or failure, these things just fall away in the face of death, leaving only what is truly important. You are already naked. There is no reason not to follow your heart." He concludes: "Your time is limited, so don't waste it living someone else's life. Don't be trapped by dogma, which is living with the results of other people's thinking. Don't let the noise of others' opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary." His final words: "Stay Hungry. Stay Foolish."

Genomic Profiling in Localized Prostate Cancer: Associations With Biochemical Recurrence and Response to Salvage Radiotherapy onlinelibrary.wiley.com/doi/10.1111/ca… Comprehensive genomic profiling in localized #ProstateCancer identified alterations in six genes🧬 (PTEN, BRCA2, POLD1, ERBB3, MYC, SETD2) associated with biochemical recurrence and worse recurrence-free survival after prostatectomy. Alteration-positive patients showed higher stage and recurrence rates. BRCA2, especially with SETD2 co-alteration, predicted poorer outcomes. These findings suggest genomic profiling may refine risk stratification, though further validation is needed before guiding management in localized disease. @OncoAlert 🚨 @Silke_Gillessen @AOmlin @weoncologists

#REVELUTION Trial: A comparative study of GnRH agonist and antagonist on coronary plaque in #ProstateCancer. @sagarapatel @WinshipAtEmory joins @l_ballas @CedarsSinai to discuss data from the REVELUTION trial which demonstrated that in men receiving pelvic RT for non-metastatic prostate cancer, leuprolide drove substantially greater coronary plaque progression than relugolix, while baseline statin use markedly blunted leuprolide-associated plaque growth. #WatchNow to learn more on UroToday > bit.ly/4qEJrJb

A nice summary of the data, to date, below. The evidence supports an overall survival benefit of adding prostate RT to mHSPC for those low burden on conventional imaging (also evidence of benefit beyond that)

Randomized comparison of MRI versus transurethral resection for staging new #BladderCancers: Final survival analysis from the #BladderPath trial. Presentation by James Catto, PhD @sheffielduni. #EAU26 written coverage by @zklaassen_md @GACancerCenter > bit.ly/41ef6H3 @Uroweb

Now at #EAU26 Nearly all pts who would have qualified for EMBARK on conventional imaging were found to have metastatic disease on PSMA PET (96%) ❓remains on whether or not this should change their management #prostatecancer @Uroweb

#EAU26 Dr. Fonteyne on MDT in oligometastatic prostate cancer: Evidence is growing, but context matters. 🔹 STOMP & ORIOLE: MDT → excellent local control, delays progression 🔹 RADIOSA: MDT + ADT > MDT alone for PFS 🔹 ARTO: MDT + SOC improved PFS and may signal OS benefit Yet major gaps remain: • Most data come from metachronous disease • Evidence in de novo oligometastatic HSPC is limited • Patient selection is key @uroweb @UroToday

#EAU26 Dr. von Amsberg on when to introduce PARPi: mHSPC or should we wait until mCRPC? 🧬 BRCA1/2-mutated mHSPC behaves differently. • Poorer prognosis • Less benefit from ARPIs/docetaxel • PARP inhibitor combinations show the strongest rPFS signal (emerging OS) in BRCA1/2 💡~1 in 4 men never receive another line of therapy → effective treatments may need to move earlier, not later. @uroweb @UroToday

Let's review taxanes in prostate cancers. Evidence for Weekly 25-30/m² - TAX327 2-weekly 50/m² - ARASAFE, PROSTY 3-weekly 75/m²- CHAARTED, STAMPEDE What's your choice? #gu #asco #gucsm #cancer #oncology

Fair point about ARPI! I don't fully agree. To be clear, I am talking here about low-volume mHSPC. Few points: 1- I wouldn't say PEACE-1 showed no OS benefit. It doesn't prove a benefit, neither does it disprove one. HR for SOC+Abi +/-RT was 0.77 (Curves below). There is certainly a trend. I think we need a higher N for the ARPI subgroup. There was however a signicant improvement in CRFS. 2- In a NMA (@soum_roy_radonc) with Bayesian pairwise comparison, the best treatment was SOC+ARPI+RT, and was associated with reduced mortality wrt SOC+ARPI europeanurology.com/article/S0302-… 3- STOPCAP meta-analysis (including PEACE-1 data) showed an OS HR of 0.92 (0.84-1.0) for RT for all-comers, low and high-volume (Forest plot below). For low-volume, OS HR was 0.79 (0.67-0.93). annalsofoncology.org/article/S0923-… urotoday.com/conference-hig… So based on the above, I think it's safe to say that RT to the primary is beneficial for low-volume mHSPC treated with ADT +/- ARPI. PEACE-1 cannot rule out an OS benefit for the ADT+ARPI subgroup, mainly due to small N and Frequentist design. It does however prove a CRFS benefit. On another hand, a Bayesian comparison (NMA above) showed that these patients most likely benefit from RT. In light of these, I think it's hard to NOT recommend RT even with ARPI. Wondering what is the current practice at your institution. Also curious to know what other Rad-Onc colleagues think about this @pcaparker @soum_roy_radonc @drspratticus @tylersbrt @seanmmcbride @sbrtsean @alison_tree @vedangmurthy @piet_ost @paulsargos @jryckman3 @5_utr @adib_elio @protonstorey @docpriyamvada @_shankarsiva @albertobossial @amarukishan

#EAU26 Congrats to the FASTRACK teams @_ShankarSiva. SBRT for RCC now has greater prospective data than all other ablative treatments and is a guideline supported SOC. Excited to continue to expand its use through the conduct of well designed clinical trials. Patients want a non-invasive option, but we must continue to generate these excellent results. @ASTRO_org @NCCN @NRGonc @ASCO