&lt;p&gt;Optimal Management of Upper Tract Urothelial Carcinoma: Current Perspectives&lt;/p&gt;

Leow, Jeffrey J.; Liu, Zhenbang; Tan, Teck Wei; Lee, Yee Mun; Yeo, Eu Kiang; Chong, Yew‐Lam

doi:10.2147/ott.s225301

Cited by 51 publications

(64 citation statements)

References 119 publications

(124 reference statements)

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“…Currently, checkpoint inhibitors have been widely rationalized in several cancers partly because of its well objective response rates and favorable efficacy ( 31 ). If PD-L1 levels in tumor cells were linked to clinical and pathological features, the PD-L1 inhibitors would inhibit the tumor biology, such as invasion, recurrence, and metastasis, etc.…”

Section: Discussionmentioning

confidence: 99%

The Prevalence and Prognostic Role of PD-L1 in Upper Tract Urothelial Carcinoma Patients Underwent Radical Nephroureterectomy: A Systematic Review and Meta-Analysis

Lü

Kang

Luo³

et al. 2020

Front. Oncol.

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Section: Discussionmentioning

confidence: 99%

The Prevalence and Prognostic Role of PD-L1 in Upper Tract Urothelial Carcinoma Patients Underwent Radical Nephroureterectomy: A Systematic Review and Meta-Analysis

Lü

Kang

Luo³

et al. 2020

Front. Oncol.

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“…As of today, standard treatment options include surgery and chemotherapy, but mainly lack successful personalized targeted therapies. 14 …”

Section: Case Reportmentioning

confidence: 99%

Use of plasma ctDNA as a potential biomarker for longitudinal monitoring of a patient with metastatic high-risk upper tract urothelial carcinoma receiving pembrolizumab and personalized neoepitope-derived multipeptide vaccinations: a case report

Blumendeller

Boehme

Frick

et al. 2021

J Immunother Cancer

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Upper tract urothelial carcinoma (UTUC) is often diagnosed late and exhibits poor prognosis. Only limited data are available concerning therapeutic regimes and potential biomarkers for disease monitoring. Standard therapies often provide only insufficient treatment options. Hence, immunotherapies and complementary approaches, such as personalized neoepitope-derived multipeptide vaccine (PNMV), come into focus. In this context, genetic analysis of tumor tissue by whole exome sequencing represents an essential diagnostic step in order to calculate tumor mutational burden (TMB) and to reveal tumor-specific neoantigens. Furthermore, disease progression is essential to be monitored. Longitudinal screening of individually known mutations in plasma circulating tumor DNA (ctDNA) by the use of next-generation sequencing and digital droplet PCR (ddPCR) might be a promising method to fill this gap.Here, we present the case of a 55-year-old man who was diagnosed with high-risk metastatic UTUC in 2015. After initial surgery and palliative chemotherapy, he developed recurrence of the tumor. Genetic analysis revealed a high TMB of 41.2 mutations per megabase suggesting a potential success of immunotherapy. Therefore, in 2016, off-label treatment with the checkpoint-inhibitor pembrolizumab was started leading to strong regression of the disease. This therapy was then discontinued due to side effects and treatment with a previously produced PNMV was started that induced strong T cell responses. During both treatments, plasma Liquid Biopsies (pLBs) were performed to measure the number of mutated molecules per mL plasma (MM/mL) of a known tumor-specific variant in the MLH1 gene by ddPCR for longitudinal monitoring. Under treatment, MM/mL was constantly zero. A few months after all therapies had been discontinued, an increase of MM/mL was detected that persisted in the following pLBs. When MRI scans proved tumor recurrence, treatment with pembrolizumab was started again leading to a rapid decrease of MM/mL in the pLB to again zero. Treatment response was then also confirmed by MRI.This case shows that use of immunotherapy and PNMV might be a promising treatment option for patients with high-risk metastatic UTUC. Furthermore, measurement of individually known tumor mutations in plasma ctDNA by the use of pLB could be a very sensitive biomarker to longitudinally monitor disease.

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“…In the multidisciplinary comprehensive treatment of UTUC, RNU and cyst sleeve resection [ 4 – 6 ] are the current gold standards of treatment. For suitable patients with low risk, some scholars have recommended kidney preservation surgery, combined with BCG or mitomycin-based intracavitary chemical and immunotherapy [ 7 ]. Regarding chemotherapy for UTUC, a meta-analysis with a sample size of 328 patients showed that [ 8 ] neoadjuvant chemotherapy before RNU may improve the survival outcomes of patients with locally advanced UTUC.…”

Section: Discussionmentioning

confidence: 99%

“…Programmed death receptor 1 (PD-1) and its ligand (PD-L1) are important negative regulators of immune activity that can prevent the destruction of normal tissue and autoimmunity. PD-1/PD-L1 drugs approved by the FDA for the treatment of urothelial cancer are passing various stages of clinical trials with good objective response rates and controllable adverse reactions [ 7 , 22 ]. In addition, some studies have found that the expression of PD-1 and PD-L1 in patients with UTUC accompanied by squamous cell differentiation is significantly higher than that in patients with simple UTUC [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Ureteral urothelial carcinoma with squamous cell carcinoma and sarcomatoid carcinoma differentiation: a case report

et al. 2021

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Background Upper urinary tract urothelial carcinoma (UTUC) with multiple pathological types is extremely rare in the clinic, but the recurrence rate and mortality these patients are high. At present, there is no standard treatment for such cases. Case presentation We reported a case of ureteral urothelial carcinoma with squamous cell carcinoma and sarcomatoid carcinoma differentiation and rapid ileal metastasis and reviewed the literature related to different pathological types of upper urinary tract tumours to explore the diagnosis, treatment and prognosis characteristics of the disease, enhance our understanding of its clinical manifestations and history of evolution and provide guidance for avoiding missed diagnosis and misdiagnosis. Conclusion There is no standard treatment for urinary malignant tumours with multiple pathological types; radical surgery is considered a suitable choice. Chemotherapy, targeted drug therapy and immunotherapy may be beneficial to the survival of patients. In short, these patients have a high risk of recurrence and metastasis and a poor prognosis.

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<p>Optimal Management of Upper Tract Urothelial Carcinoma: Current Perspectives</p>

Cited by 51 publications

References 119 publications

The Prevalence and Prognostic Role of PD-L1 in Upper Tract Urothelial Carcinoma Patients Underwent Radical Nephroureterectomy: A Systematic Review and Meta-Analysis

The Prevalence and Prognostic Role of PD-L1 in Upper Tract Urothelial Carcinoma Patients Underwent Radical Nephroureterectomy: A Systematic Review and Meta-Analysis

Use of plasma ctDNA as a potential biomarker for longitudinal monitoring of a patient with metastatic high-risk upper tract urothelial carcinoma receiving pembrolizumab and personalized neoepitope-derived multipeptide vaccinations: a case report

Ureteral urothelial carcinoma with squamous cell carcinoma and sarcomatoid carcinoma differentiation: a case report

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