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Advanced urothelial carcinoma usually responds to platinum-based chemotherapy (CT), although overall survival (OS) and progression-free survival are typically short. Immunotherapy is a promising treatment strategy, but the first-line benefits in platinum-eligible patients are limited, and its combination with first-line chemotherapy has not been shown to benefit OS. Maintenance with immunotherapy in patients with clinical benefit is a strategy that takes advantage of the immunogenic effects of CT, as well as its antitumor activity and safety. Avelumab is the only inhibitor approved for first-line maintenance in patients with locally advanced or metastatic urothelial carcinoma that has not progressed with platinum-based CT. International guidelines recommend first-line maintenance avelumab as the standard of care for locally advanced or metastatic urothelial carcinoma that has not progressed with first-line chemotherapy.

Antecedentes: El dietilestilbestrol (DES) a dosis bajas en cáncer de próstata metastásico resistente a la castración (CPRCm) está poco estudiado en pacientes altamente pretratados con terapias contemporáneas. Describimos la eficacia y tolerabilidad del tratamiento con dosis bajas de DES en pacientes con CPRCm. Material y métodos: Estudio de cohorte retrospectivo de un centro de pacientes, entre 2005 y 2020, con CPRCm tratados con DES. Resultados: Se evaluaron 34 pacientes, mediana de edad 74 años (rango: 56-94), mediana de tratamientos previos 3 (rango: 1-7). El 64.7% había recibido quimioterapia. Se observó respuesta bioquímica en 10/32 pacientes (31.3%). La mediana de supervivencia libre de progresión (SLPm) fue 3.7 meses. La mediana de supervivencia global (SGm) fue 9.7 meses. Los eventos adversos más comunes fueron fatiga, ginecomastia y náuseas. Ocurrieron dos defunciones por trombosis arterial. Conclusión: El DES a dosis bajas es activo en pacientes altamente pretratados, con SLPm equiparable a otros tratamientos disponibles. La selección de pacientes es importante para la seguridad del tratamiento.

Young women with cancer comprise a special population of patients who experience cancer and oncologic care in a unique way. Recent progress in diagnostic and therapeutic approaches has transformed the landscape of clinical oncology practice. This perspective addresses novel therapies, and some of the main challenges that oncologists face when providing care for young patients in the era of next-generation sequencing and tissue-agnostic approaches through the use of targeted therapies for diverse malignancies.