The 2025 American Society of Clinical Oncology Genitourinary Cancers Symposium (ASCO GU 2025) was held from February 13 to 15 in San Francisco, showcasing the latest research and treatment strategies in the field of urological oncology from experts worldwide. Several clinical research findings from Dr. Hongqian Guo’s team at Nanjing Drum Tower Hospital were selected for presentation, covering a wide range of topics, including non-clear cell renal cell carcinoma (nccRCC), small renal tumors, metastatic hormone-sensitive prostate cancer (mHSPC), upper tract urothelial carcinoma (UTUC), and bladder cancer. Urology Frontier invited Professors Xuefeng Qiu, Shun Zhang, Guangxiang Liu, Yifan Sun, and Dr. Xi Zheng from Nanjing Drum Tower Hospital to share their insights.Urology Frontier: Among the many research advances presented at this conference, which findings were of greatest interest to you?
Dr. Xuefeng Qiu stated that on the first day of ASCO GU 2025, significant advances in prostate cancer research were presented. His subspecialty focus is on prostate cancer, and he was particularly interested in the newly released overall survival (OS) data from the TALAPRO-2 study. Previous studies such as PROpel and MAGNITUDE had already demonstrated the benefits of combination therapy for metastatic castration-resistant prostate cancer (mCRPC) patients with homologous recombination repair (HRR) mutations, but certain limitations remained. TALAPRO-2 not only confirmed the progression-free survival (PFS) benefit of PARP inhibitor combination therapy but also achieved a major breakthrough in OS, which is considered the gold-standard endpoint. These findings have significant implications for the future of first-line PARP inhibitor treatment in mCRPC. He expressed his eagerness to collaborate with colleagues in further exploring this treatment approach.
Dr. Guangxiang Liu shared that he was honored to attend the ASCO GU meeting in San Francisco. While no groundbreaking advances were made in renal cancer research, two important studies released their final results. The first was the COSMIC-313 trial, which evaluated the combination of cabozantinib, nivolumab, and ipilimumab. The three-year follow-up data reinforced the importance of this combination in advanced renal cancer treatment. The second was the CheckMate-9ER study, which reported a 60-month PFS rate of 13.6% (compared to 3.6% in the control group) and a median OS of 46.5 months (compared to 35 months in the control group). Notably, the combination of cabozantinib and nivolumab demonstrated superior efficacy with no new safety concerns.
Dr. Yifan Sun stated that he focused on minimally invasive therapies for urological tumors at this year’s ASCO GU meeting. His research contribution was related to radiofrequency ablation (RFA) for renal tumors. Multiple studies have demonstrated that for small renal tumors and patients with high surgical risks due to advanced age or multiple comorbidities, RFA offers substantial benefits without increasing surgical risk. He also paid close attention to minimally invasive treatments for prostate cancer, including laparoscopic surgery, cryoablation, radiofrequency ablation, and laser therapy. He believes that for elderly patients and those with poor overall health status, minimally invasive approaches are emerging as an important treatment trend that can improve patient outcomes.
Dr. Xi Zheng expressed that he attended ASCO GU with a strong desire to learn and engage in in-depth discussions on the latest developments in urological oncology. As he has yet to determine his specific subspecialty focus, he showed keen interest in prostate cancer, bladder cancer, and renal cancer. On the first day of the conference, he was particularly drawn to studies on prostate-specific membrane antigen (PSMA). Whether in diagnostics or treatment, PSMA has become a major focus in current clinical trials, and he is confident that it will play a transformative role in future prostate cancer management. Additionally, significant findings were released on bladder cancer and renal cancer during the second and third days of the conference, respectively. He intends to continue studying these topics in depth and looks forward to further discussions and exchanges with his peers.
Urology Frontier: The Nanjing Drum Tower Hospital Research Team Presented Multiple Studies at ASCO GU. Dr. Xuefeng Qiu, How Should Clinicians Approach Treatment Selection for mHSPC Patients with HRR Mutations? Could You Share the Background and Progress of the PROact Study?
Dr. Xuefeng Qiu:This is a highly relevant and cutting-edge question. When designing the PROact study, we carefully considered the application background of PARP inhibitors. At the time, overall survival (OS) data for PARP inhibitors such as talazoparib had not yet been released. Today, with the presentation of the latest OS data from the TALAPRO-2 study at ASCO GU, we are prompted to reflect more deeply on this issue.
I would like to address this from two perspectives. First, regarding treatment strategies in metastatic hormone-sensitive prostate cancer (mHSPC). PARP inhibitors have significant potential in the mHSPC setting. However, the PROact study, as a single-arm, prospective Phase II clinical trial, remains in the exploratory stage. This study focuses on newly diagnosed mHSPC patients with at least one HRR gene mutation, treating them with abiraterone combined with olaparib at standard monotherapy doses. Current findings indicate good tolerability, with an objective response rate (ORR) of 84% among 13 evaluable patients, demonstrating promising efficacy. However, these are only preliminary results, and large-scale Phase III trials with control arms are needed to further validate the role of olaparib in mHSPC.
Second, regarding treatment strategies in metastatic castration-resistant prostate cancer (mCRPC). The integration of PARP inhibitors into precision medicine for prostate cancer began five years ago. Since the PROfound study in 2020 demonstrated the benefit of PARP inhibitors for mHSPC and mCRPC patients with HRR mutations, precision-targeted therapy for prostate cancer has entered a new era. This research has led clinicians and researchers to explore whether these therapies could be moved from late-line to front-line treatment.
To investigate this, three large-scale studies—PROpel, TALAPRO-2, and MAGNITUDE—were conducted, evaluating first-line combination therapy with PARP inhibitors in mCRPC patients. With the release of the final OS data from TALAPRO-2, an analysis of all three studies confirms that patients with HRR mutations, particularly BRCA mutations, derive the greatest benefit, whereas those without HRR mutations show relatively limited improvement. This suggests that in the future, mCRPC patients with HRR mutations, especially BRCA mutations, will benefit the most from first-line PARP inhibitor therapy.
In summary, PARP inhibitors demonstrate tremendous potential in both mHSPC and mCRPC. Their efficacy is particularly pronounced in patients with HRR mutations, providing a clear direction for future research and clinical applications.
Urology Frontier: Dr. Shun Zhang, What Are the Current Challenges in the Treatment of UTUC? How Does the Targeted and Immunotherapy Combination You Presented at the Conference Benefit Patients?
Dr. Shun Zhang:It is well known that urothelial carcinoma consists of upper and lower urinary tract cancers. The lower urinary tract mainly refers to bladder cancer, while the upper urinary tract includes renal pelvis and ureteral cancers, collectively referred to as upper tract urothelial carcinoma (UTUC). Although UTUC and bladder cancer both fall under the category of urothelial carcinoma, they exhibit significant differences in terms of molecular characteristics, anatomical structure, and clinical management.
Currently, radical nephroureterectomy is the standard surgical treatment for UTUC. However, in high-risk UTUC patients, surgery alone often fails to achieve complete tumor control, with a recurrence rate as high as 40% within two years postoperatively.
Regarding adjuvant therapy after surgery, a previous Phase III clinical study investigated platinum-based chemotherapy in high-risk UTUC patients (T2-T4, N0-N3). The study demonstrated that compared to active surveillance, postoperative platinum-based chemotherapy significantly improved disease-free survival (DFS), with 3-year DFS and 5-year DFS increasing by 21% and 17%, respectively. Additionally, the chemotherapy group had a lower risk of distant metastasis and mortality. However, no statistically significant improvement in overall survival (OS) was observed. Furthermore, many UTUC patients experience impaired renal function after nephrectomy, preventing them from receiving platinum-based chemotherapy postoperatively.
On the other hand, the CheckMate 274 trial evaluated the efficacy and safety of nivolumab compared to placebo in muscle-invasive bladder cancer (MIBC) patients at high risk of recurrence after radical surgery. The study demonstrated significant improvements in DFS and OS with nivolumab, and this year’s ASCO GU conference presented updated OS analysis, including subgroup data. Based on its demonstrated benefits, nivolumab has been approved for clinical use in multiple countries, including China, the U.S., and Europe.
However, when applied to UTUC patients, immune checkpoint inhibitors did not show a significant advantage over placebo. Given the challenges in adjuvant treatment for UTUC, we began to explore alternative strategies.
Since the approval of vedicitumab (RC48) in China in June 2021, it has become the first domestically approved ADC (antibody-drug conjugate) for urothelial carcinoma. At this ASCO GU meeting, our team presented a retrospective study evaluating the efficacy of vedicitumab combined with toripalimab in adjuvant treatment for UTUC.
The early phase of this study coincided with the approval of vedicitumab, so the initial focus was on advanced-stage patients. As the price of the drug decreased and the RC48-C014 study progressed, we gained further clinical experience. This led us to consider applying this combination for adjuvant treatment in high-risk UTUC patients with high HER2 expression.
After thorough discussion with patients and obtaining informed consent, we administered 8 cycles of vedicitumab in combination with 26 cycles of toripalimab. Between 2022 and 2024, we collected data from 12 patients treated with this regimen. Additionally, 24 high-risk HER2-positive patients did not receive any adjuvant therapy due to various reasons.
Following one year of follow-up, our results showed that the 12-month DFS rate was 91% in the targeted and immunotherapy combination group, compared to 62.5% in the observation group. These findings suggest promising potential for vedicitumab combined with toripalimab in UTUC adjuvant treatment.
Regarding treatment-related adverse events, the overall incidence of Grade 3 adverse reactions was relatively low, and no unexpected toxicities were observed. All side effects were within the expected range, with no newly identified safety concerns.
From this small-scale retrospective study, we can draw the following conclusions:
- The combination of toripalimab and vedicitumab demonstrates clear short-term efficacy in HER2-positive UTUC patients, though long-term follow-up is needed.
- The safety profile of this regimen is acceptable, making it a viable option for broader clinical use.
Looking ahead, we hope to collaborate with more centers or pharmaceutical companies to conduct higher-level randomized controlled trials (RCTs) to further confirm the efficacy and safety of this targeted and immunotherapy combination in UTUC adjuvant treatment.
Urology Frontier: Dr. Guangxiang Liu, Could You Share Your Team’s Latest Research Progress in Kidney Cancer, Particularly in nccRCC?
Dr. Guangxiang Liu:At this year’s ASCO GU conference, a total of 229 abstracts on kidney cancer were presented. However, research on non-clear cell renal cell carcinoma (nccRCC) was relatively scarce, with only 18 studies selected, including our team’s research. The motivation behind our study stems from the fact that nccRCC is characterized by high malignancy, significant heterogeneity, and poor prognosis. This is especially true for high-risk patients, who face a substantial risk of postoperative recurrence and metastasis.
Currently, the majority of kidney cancer research focuses on clear cell renal cell carcinoma (ccRCC), while treatment strategies for nccRCC are often extrapolated from ccRCC studies. However, the specific efficacy of these treatments in nccRCC remains under investigation. Led by Dr. Hongqian Guo, our study explored the efficacy of adjuvant therapy in nccRCC patients, particularly the potential benefits of targeted and immunotherapy combinations for high-risk patients.
In ccRCC, first-line treatment predominantly consists of targeted and immune-based therapies. However, positive results in adjuvant therapy remain limited, with KEYNOTE-564 being one of the few studies demonstrating the benefit of single-agent immunotherapy. In the context of nccRCC, some studies suggest that patients with advanced disease may benefit more from combination immunotherapy. Based on this understanding, we aimed to move these treatment strategies forward into the adjuvant setting, hoping to provide greater benefits to high-risk patients.
From our current data analysis, this approach has shown promising efficacy, and so far, no cases of recurrence or metastasis have been observed. Moving forward, we will continue to monitor long-term outcomes and explore the optimal adjuvant strategies for nccRCC, aiming to fill this critical gap in kidney cancer treatment.
Urology Frontier: Dr. Yifan Sun, There Are Multiple Approaches for Treating Small Renal Tumors in Clinical Practice. How Do You View the Role of Radiofrequency Ablation (RFA)? What Progress Has Your Team Made in This Field?
Dr. Yifan Sun: Minimally invasive treatments for small renal tumors include partial nephrectomy, radiofrequency ablation (RFA), and cryoablation. Currently, partial nephrectomy remains the most commonly used surgical approach. However, for elderly patients, those with severe comorbidities, or individuals who cannot tolerate general anesthesia and intubation, RFA can provide a favorable prognosis under specific conditions.
Under the guidance of Dr. Hongqian Guo, our team was among the first in China to conduct RFA procedures for renal tumors. Since 2008, we initially started with monopolar RFA probes and have gradually refined our techniques in close collaboration with radiologists and pathologists. By 2019, we adopted bipolar RFA, along with dual-image guidance using ultrasound and CT, which improved tumor localization precision compared to conventional ultrasound-only guidance. This allowed for complete ablation of renal tumors smaller than 3 cm within 10 to 15 minutes. After 3 to 5 years of follow-up, we found that patient outcomes were comparable to those undergoing partial nephrectomy, with no statistically significant difference in prognosis.
More recently, we have begun performing RFA under local anesthesia, making it accessible for patients previously deemed ineligible due to anesthesia risks. Our findings suggest that for patients who cannot undergo general anesthesia, particularly the elderly, RFA offers a distinct advantage in small renal tumor treatment.
Urology Frontier: Dr. Xi Zheng, What Progress Has Your Team Made in Bladder Cancer Research? Based on These Findings, What Future Directions Will You Explore?
Dr. Xi Zheng:Dr. Shun Zhang has already discussed our team’s clinical research on urothelial carcinoma. This time, our study focused on the mechanisms underlying bladder tumor development and progression. In China, bladder cancer has a high incidence in men and is associated with high recurrence rates and significant malignancy. Bladder cancer is typically classified into non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC). Unlike prostate cancer, which benefits from biomarkers like PSA for diagnosis and monitoring, no widely effective biomarkers currently exist for bladder cancer across different stages and genetic backgrounds.
Under the leadership of Dr. Hongqian Guo, our team at Nanjing Drum Tower Hospital has collaborated with Worms University of Applied Sciences in Germany to investigate key genetic factors in bladder cancer using CRISPR-Cas9 screening and soft agar colony formation assays. Our study has been recognized at ASCO GU, validating the significance of our research and motivating us to further explore this direction.
Moving forward, we plan to expand our research by developing in vitro organoid models using murine bladder tissue and conducting in vivo screening to identify key genes involved in different genetic subtypes of bladder cancer. By delving deeper into the mechanisms of these genes, our goal is to establish a biomarker system for bladder cancer similar to PSA for prostate cancer, which could significantly improve precision diagnostics and personalized treatment strategies for bladder cancer.
Dr. Xuefeng Qiu: I would like to extend my gratitude to the ASCO GU conference and Urology Frontier for giving us the opportunity to present our research on an international stage. The Nanjing Drum Tower Hospital Urology Team has a unique focus. While we are a top-tier tertiary hospital’s urology department, our clinical and research efforts are dedicated primarily to urological oncology.
Each of our team members has a specialized area of expertise. My primary focus is prostate cancer research, while Dr. Guangxiang Liu specializes in kidney cancer and kidney transplantation, and Dr. Shun Zhang is dedicated to prostate cancer and urothelial carcinoma. Our younger physicians, though still exploring their specific subspecialties, will undoubtedly become experts in their respective fields in the future.
This subspecialty-driven approach not only aligns with the requirements of a tertiary hospital but also allows us to conduct more in-depth clinical research. Our participation in ASCO GU and other international conferences has not only broadened our perspectives but has also enabled us to grow academically. Over the years, I have progressed from simply attending and listening to presentations to having our own research selected for presentation and even collaborating with international experts. This evolution reflects the expanding global vision and academic influence of our team.
As a team, we share a common dream and goal: to conduct research capable of influencing international clinical guidelines and to one day stand on the world’s most prestigious academic stage to present breakthroughs from China and research specifically tailored to the Chinese population. Achieving this milestone would not only recognize our team’s long-term dedication but also affirm China’s contributions to the field of urological oncology on the global stage.
Dr. Hongqian Guo
- Chair, Department of Urology, Nanjing Drum Tower Hospital
- Director, Urological Research Institute, Nanjing University
- Chief Physician, Professor at Nanjing University
- Recipient of the State Council Special Government Allowance
- Doctoral Supervisor at Nanjing University, Nanjing Medical University, Xuzhou Medical University, and Nanjing University of Chinese Medicine
- Expertise: Complex urological malignancies, kidney transplantation, and minimally invasive urological surgery, particularly precision robotic surgery for urological cancers. He has led over 13,000 robotic surgeries, maintaining the highest annual surgical volume in China and ranking first globally in individual robotic surgery volume for five consecutive years.
- Publications: Corresponding author of multiple papers in Molecular Cell, Nature Communications, Journal of Hematology & Oncology, Cancer Research, Journal of Urology, Journal of Nuclear Medicine, and other prestigious journals.
- Research Leadership: Principal investigator of five National Natural Science Foundation projects, recipient of ten provincial and municipal medical awards.
- Professional Roles: Director, Jiangsu Provincial Urology Quality Control Center Chair, Jiangsu Provincial Medical Robotics Committee Chair, Urological Disease Prevention and Control Committee, Jiangsu Preventive Medicine Association Member, Chinese Medical Doctor Association Robotic Surgery Committee Member, Chinese Medical Doctor Association Urology Committee
Dr. Xuefeng Qiu
- Associate Chief Physician, Department of Urology, Nanjing Drum Tower Hospital
- Associate Professor, Nanjing University Medical School
- Doctorate in Medicine, Postdoctoral Researcher at UCSF and Nanjing University Life Sciences Institute
- Master’s Supervisor at Nanjing University, Nanjing Medical University, and Nanjing University of Chinese Medicine
- Recognized Talent in Jiangsu’s “333 High-Level Talent Training Program”
- Selected for Nanjing’s Young Talent Training Program
- Secretary of the Jiangsu Medical Robotics Professional Committee
Dr. Shun Zhang
- Associate Chief Physician, Department of Urology, Nanjing Drum Tower Hospital
- Doctorate in Medicine
- Committee Member, Translational Research Group, Chinese Medical Doctor Association Urology Committee
- Committee Member, Chinese Society of Geriatrics and Gerontology
- Expertise: Systemic treatment of urological cancers, including chemotherapy, immunotherapy, targeted therapy, and comprehensive management.
- Clinical Research: Lead investigator in over 40 clinical trials in urology.
- Deep understanding of novel global drug developments in urological oncology.
Dr. Guangxiang Liu
- Chief Physician, Department of Urology, Nanjing Drum Tower Hospital
- Medical Doctor, Team Leader in Urological Surgery
- Expertise: Kidney cancer, kidney transplantation
- Committee Member, Organ Transplantation Branch, Jiangsu Medical Doctor Association
- Committee Member, Renal Transplantation Division, Jiangsu Urology Association
- Committee Member, Jiangsu Translational Medicine Association
- Editorial Board Member, Journal of Robotic Surgery, Journal of Urology (Electronic Edition)
- Publications: Authored 25 research papers, including 15 SCI-indexed papers
- Research Leadership: Principal investigator in multiple national and provincial research projects
Dr. Yifan Sun
- Department of Urology, Nanjing Drum Tower Hospital
Dr. Xi Zheng
- Department of Urology, Nanjing Drum Tower Hospital
