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World Journal of Urology

, Volume 36, Issue 12, pp 2027–2034 | Cite as

Salvage topical therapy for upper tract urothelial carcinoma

  • Adithya Balasubramanian
  • Michael J. Metcalfe
  • Gavin Wagenheim
  • Lianchun Xiao
  • John Papadopoulos
  • Neema Navai
  • John W. Davis
  • Jose A. Karam
  • Ashish M. Kamat
  • Christopher G. Wood
  • Colin P. Dinney
  • Surena F. Matin
Original Article

Abstract

Purpose

Topical therapy (TT) for upper tract urothelial carcinoma (UTUC) has been explored as a kidney sparing approach to treat carcinoma in situ (CIS) and as adjuvant for endoscopically treated Ta/T1 tumors. In bladder cancer, data support use of salvage TT for repeat induction. We investigate the outcomes of salvage TT for UTUC in patients ineligible for or refusing nephroureterectomy.

Methods

A single-center retrospective review on patients receiving salvage TT via percutaneous nephrostomy tube or cystoscopically placed ureteral catheters was performed. Primary outcome was response to therapy based on International Bladder Cancer Group criteria.

Results

51 patients with 58 renal units (RUs) received TT. Of these, 17 patients with 18 RUs received the second-line TT, with a median follow-up of 36.5 months (IQR 24.5–67 months). 44% (8/18) received salvage TT for refractory disease and 56% (10/18) as reinduction. 5 RUs with CIS were unresponsive to initial TT and went on to receive salvage TT, of which 20% (1/5) responded. 13 RUs recurred or relapsed following initial TT and received salvage TT for papillary tumors, with 62% (8/13) responding.

Conclusion

Our data provide preliminary clinical rationale for the second-line TT for refractory and recurrent, endoscopically managed papillary UTUC in patients ineligible for or refusing nephroureterectomy. However, refractory upper tract CIS appears to have poor response to salvage TT.

Keywords

Upper tract urothelial carcinoma Chemotherapy Ureteral cancer Topical therapy Renal pelvis cancer 

Notes

Acknowledgements

We would like to recognize support from the Monteleone Family Foundation Endowment for Research in Kidney and Bladder Cancer, and the Eleanor and Scott Petty Fund for Upper Tract Urothelial Cancer Research.

Author contribution

Balasubramanian: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. Metcalfe: data collection or management, data analysis, manuscript, and writing/editing. Wagenheim: data collection or management, data analysis, manuscript, and writing/editing. Xiao: data collection or management, data analysis, and manuscript writing/editing. Papadopoulos: data collection or management and manuscript writing/editing. Navai: data collection or management and manuscript writing/editing. Davis: data collection or management and manuscript writing/editing. Karam: data collection or management and manuscript writing/editing. Kamat: data collection or management and manuscript writing/editing. Wood: data collection or management and manuscript writing/editing. Dinney: data collection or management and manuscript writing/editing. Matin: protocol/project development, data collection or management, data analysis, and manuscript writing/editing.

Compliance with ethical standards

Conflict of interest

A. Kamat is a consultant to the following companies; Photocure, Telesta Therapeutics, Sanofi, Merck, Abbott Molecular, Theralase, Heat Biologics, Spectrum Pharmaceuticals and Oncogenix and has received research funding from FKD Industries; In addition, A. Kamat has a patent CyPRIT-Cytokine Panel for Response to Intravesical Immunotherapy pending. J. Karam is a consultant to the following companies: Pfizer, EMD Serono and Novartis. C. Dinney is a paid consultant to FKD Therapies. The corresponding author is a consultant to the following companies: Taris, Urogen, and Peloton Therapeutics and has received research funding from AT&T Foundation and Specialized Program in Oncology Research (SPORE).

Ethical standards

This review does not involve human subjects and meets Helsinki declaration for protection of human subjects.

References

  1. 1.
    Soria F, Shariat SF, Lerner SP et al (2017) Epidemiology, diagnosis, preoperative evaluation and prognostic assessment of upper-tract urothelial carcinoma (UTUC). World J Urol 35(3):379–387CrossRefPubMedGoogle Scholar
  2. 2.
    Raman JD, Scherr DS (2007) Management of patients with upper urinary tract transitional cell carcinoma. Nat Clin Pract Urol 4(8):432–443CrossRefPubMedGoogle Scholar
  3. 3.
    Zigeuner R, Pummer K (2008) Urothelial carcinoma of the upper urinary tract: surgical approach and prognostic factors. Eur Urol 53(4):720–731CrossRefPubMedGoogle Scholar
  4. 4.
    Roupret M, Babjuk M, Comperat E et al (2013) European guidelines on upper tract urothelial carcinomas: 2013 update. Eur Urol 63(6):1059–1071CrossRefPubMedGoogle Scholar
  5. 5.
    Mork M, Hubosky SG, Roupret M et al (2015) Lynch syndrome: a primer for urologists and panel recommendations. J Urol 194(1):21–29CrossRefPubMedGoogle Scholar
  6. 6.
    Johnson GB, Fraiman M, Grasso M (2005) Broadening experience with the retrograde endoscopic management of upper urinary tract urothelial malignancies. BJU Int 95:110–113CrossRefPubMedGoogle Scholar
  7. 7.
    Roupret M, Babjuk M, Comperat E et al (2015) European association of urology guidelines on upper urinary tract urothelial cell carcinoma: 2015 update. Eur Urol 68(5):868–879CrossRefPubMedGoogle Scholar
  8. 8.
    Keeley FX, Bibbo M, Bagley DH (1997) Ureteroscopic treatment and surveillance of upper urinary tract transitional cell carcinoma. J Urol 157(5):1560–1565CrossRefPubMedGoogle Scholar
  9. 9.
    Musi G, Mistretta FA, Marenghi C et al (2018) Thulium laser treatment of upper urinary tract carcinoma: a multi-institutional analysis of surgical and oncological outcomes. J Endourol 32(3):257–263CrossRefPubMedGoogle Scholar
  10. 10.
    Veeratterapillay R, Heer R, Johnson MI, Persad R, Bach C (2016) High-risk non-muscle-invasive bladder cancer-therapy options during intravesical BCG shortage. Curr Urol Rep 17(9):68CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Shariat SF, Stenzl A. Upper tract urothelial carcinoma (UTUC) a joint SIU-ICUD International Consultation. Published by the Société Internationale d’Urologie (SIU) http://www.siu-urology.org. 2013
  12. 12.
    Giannarini G, Kessler TM, Birkhauser FD, Thalmann GN, Studer UE (2011) Antegrade perfusion with bacillus Calmette–Guerin in patients with non-muscle-invasive urothelial carcinoma of the upper urinary tract: who may benefit? Eur Urol 60(5):955–960CrossRefPubMedGoogle Scholar
  13. 13.
    Metcalfe M, Wagenheim G, Xiao LC et al (2017) Induction and maintenance adjuvant mitomycin C topical therapy for upper tract urothelial carcinoma: tolerability and intermediate term outcomes. J Endourol 31(9):946–953CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Dinney CPN, Greenberg RE, Steinberg GD (2013) Intravesical valrubicin in patients with bladder carcinoma in situ and contraindication to or failure after bacillus Calmette–Guerin. Urol Oncol-Semin Ori 31(8):1635–1642CrossRefGoogle Scholar
  15. 15.
    Tang DH, Chang SS (2015) Management of carcinoma in situ of the bladder: best practice and recent developments. Ther Adv Urol 7(6):351–364CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    von Rundstedt FC, Lerner SP (2015) Bacille–Calmette–Guerin non-responders: how to manage. Transl Androl Urol 4(3):244–253Google Scholar
  17. 17.
    Lamm DL (2000) Preventing progression and improving survival with BCG maintenance. Eur Urol 37:9–15CrossRefPubMedGoogle Scholar
  18. 18.
    Kamat AM, Sylvester RJ, Bohle A et al (2016) Definitions, end points, and clinical trial designs for non-muscle-invasive bladder cancer: recommendations from the international bladder cancer group. J Clin Oncol 34(16):1935CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Palou J, Piovesan LF, Huguet J, Salvador J, Vicente J, Villavicencio H (2004) Percutaneous nephroscopic management of upper urinary tract transitional cell carcinoma: recurrence and long-term followup. J Urol 172(1):66–69CrossRefPubMedGoogle Scholar
  20. 20.
    Martinez-Pineiro JA, Garcia Matres MJ, Martinez-Pineiro L (1996) Endourological treatment of upper tract urothelial carcinomas: analysis of a series of 59 tumors. J Urol 156(2 Pt 1):377–385CrossRefPubMedGoogle Scholar
  21. 21.
    Luciani LG, Neulander E, Murphy WM, Wajsman Z (2001) Risk of continued intravesical therapy and delayed cystectomy in BCG-refractory superficial bladder cancer: an investigational approach. Urology 58(3):376–379CrossRefPubMedGoogle Scholar
  22. 22.
    Lam JS, Benson MC, O’Donnell MA et al (2003) Bacillus Calmete–Guerin plus interferon-alpha2B intravesical therapy maintains an extended treatment plan for superficial bladder cancer with minimal toxicity. Urol Oncol 21(5):354–360CrossRefPubMedGoogle Scholar
  23. 23.
    Punnen SP, Chin JL, Jewett MA (2003) Management of bacillus Calmette–Guerin (BCG) refractory superficial bladder cancer: results with intravesical BCG and interferon combination therapy. Can J Urol 10(2):1790–1795PubMedGoogle Scholar
  24. 24.
    Aboumarzouk OM, Somani B, Ahmad S, Nabi G, Townell N, Kata SG (2013) Mitomycin C instillation following ureterorenoscopic laser ablation of upper urinary tract carcinoma. Urol Ann 5(3):184–189CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Adithya Balasubramanian
    • 1
    • 2
  • Michael J. Metcalfe
    • 1
  • Gavin Wagenheim
    • 1
  • Lianchun Xiao
    • 1
    • 3
  • John Papadopoulos
    • 1
  • Neema Navai
    • 1
  • John W. Davis
    • 1
  • Jose A. Karam
    • 1
  • Ashish M. Kamat
    • 1
  • Christopher G. Wood
    • 1
  • Colin P. Dinney
    • 1
  • Surena F. Matin
    • 1
  1. 1.Department of UrologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Baylor College of MedicineHoustonUSA
  3. 3.Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonUSA

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