Genitourinary (GU) cancers, including prostate cancer, are the most common among men, and Rohan Garje, MBBS, clinical assistant professor in the Division of Hematology, Oncology, and Marrow Transplantation, has made them his singular focus. With two publications in the last month and multiple projects underway, the former fellow and recent addition to the faculty is using his Iowa-gained clinical and research experience to improve the treatment of people with GU cancer who come to the Holden Comprehensive Cancer Center (HCCC).

Publications
In a study published in Clinical Genitourinary Cancer, Garje examined data from the National Cancer Database (NCDB) and compared the trends of utilization and survival rates between surgical castration and medical castration for the treatment of prostate cancer. The study revealed that out of 33,585 patients, 94.1% had medical castration, while 5.9% chose to have a surgical castration.

Garje identified trends in the data, finding that non-Caucasian patients with lower median incomes and non-private insurance were more likely to undergo surgical castration. Academic centers had lower surgical castration rates. The study showed that the use of surgical castration has declined despite similar efficacy as medical castration. The data suggested that increasing the less-expensive surgical castration over the costlier medical castration could help reduce health care costs. Patients and physicians, Garje and his co-authors state, need to be made aware of treatment options and their financial implications.

Garje has also been summarizing the newer treatment strategies for kidney cancers, serving as first author on a publication for Cancers last month. “In the past decade, there has been a paradigm shift in the understanding of kidney cancers, which led to the development of multiple therapeutic agents. Most recently, checkpoint inhibitors were shown to have excellent clinical efficacy,” Garje said.

Clinical Associate Professor Yousef Zakharia, MD; oncology fellow Josiah An, MD; and third-year resident Austin Greco, MD, were also authors on this study. Garje and his co-authors reviewed multiple reported and ongoing clinical trials researching the effectiveness of the PD-1/PD-L1 inhibitors when combined with either ipilimumab or anti-VEGF targeted therapy.

Garje will also soon publish an article in Frontiers in Oncology, where his team examines the Poly(ADP-ribose) polymerase (PARP) inhibitors. PARP inhibitors are effective treatment options used in people with ovarian and breast cancer. The authors will discuss the safety, rationale, and efficacy when applying the PARP inhibitors to prostate and urothelial cancers.

Trials
Garje also has several ongoing clinical trials that may benefit patients with genitourinary cancers. The “VISION” study uses novel radioligand therapy to treat patients with prostate cancer. He was able to enroll several patients and has had referrals from Mayo Clinic and institutions in the Chicago area. He is planning to open additional clinical trials using these promising therapeutic agents.

He is the principal investigator for the ongoing phase I clinical trial, called AVETAX, which examines a new treatment combination of the chemotherapeutic agent (Docetaxel) and immunotherapy (Avelumab) to improve the outcomes of patients with cancers of the urinary system. This trial is funded by the HCCC and Pfizer.

“This is a novel combination strategy, and the preliminary study analysis has shown good response,” Garje said. This week, he is presenting the study results at the American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium in San Francisco.

What’s Next
Still relatively new in his career as faculty in Internal Medicine, Garje is already passing on what he has learned, mentoring fellows and residents in their research projects. In

addition to the Cancers publication noted above, Garje also worked with An as he prepared an oral presentation on glioblastoma treatment outcomes in adolescents and young adults. An delivered the presentation at the annual Society of Neuro-Oncology meeting in Phoenix last November. “Though this was not a GU oncology topic, this was a study on NCDB, which I am interested in.” Garje is currently in the middle of four different retrospective studies using the NCDB.

All of the above, in additition to two other forthcoming review articles—one focused on bladder cancer and the other on kidney cancer—paint a picture of an oncologist working against the clock.