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Salvage topical therapy for upper tract urothelial carcinoma

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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.

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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.

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Authors and Affiliations

  1. Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA

    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

  2. Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA

    Adithya Balasubramanian

  3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1411, Houston, TX, 77230, USA

    Lianchun Xiao

Authors
  1. Adithya Balasubramanian
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  2. Michael J. Metcalfe
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  3. Gavin Wagenheim
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  4. Lianchun Xiao
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  6. Neema Navai
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  7. John W. Davis
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  9. Ashish M. Kamat
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  10. Christopher G. Wood
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  11. Colin P. Dinney
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  12. Surena F. Matin
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Contributions

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.

Corresponding author

Correspondence to Surena F. Matin.

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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).

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

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Balasubramanian, A., Metcalfe, M.J., Wagenheim, G. et al. Salvage topical therapy for upper tract urothelial carcinoma. World J Urol 36, 2027–2034 (2018). https://doi.org/10.1007/s00345-018-2349-9

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  • DOI: https://doi.org/10.1007/s00345-018-2349-9

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