Upper tract urothelial carcinoma topical issue 2016: treatment of metastatic cancer

Pham, Minh; Apolo, Andrea B.; Santis, Maria De; Galsky, Matthew D.; Leibovich, Bradley C.; Pisters, Louis L.; Siefker-Radtke, Arlene; Sonpavde, Guru; Steinberg, G. D.; Sternberg, Cora N.; Tagawa, Scott T.; Weizer, Alon Z.; Woods, Michael; Milowsky, Matthew I.

doi:10.1007/s00345-016-1885-4

Cited by 8 publications

(6 citation statements)

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“…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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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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“…Perhaps potentially less toxic agents now approved for UC could increase utilisation of a watchful‐waiting approach. Immunotherapy with checkpoint inhibitors, including both programmed death‐1 (PD‐1) and programmed death ligand‐1 (PD‐L1) antibodies, represent a novel strategy to treat advanced UTUC . Several checkpoint inhibitors are now approved as second‐line therapy for metastatic UC and could play a role in palliative UTUC treatment, potentially expanding the future role of watchful waiting in this disease .…”

Section: Discussionmentioning

confidence: 99%

Survival outcomes for patients with localised upper tract urothelial carcinoma managed with non‐definitive treatment

et al. 2017

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ObjectiveTo investigate the outcomes of patients with upper tract urothelial carcinoma (UTUC) with non-definitive therapy, which currently remains unknown. Patients and MethodsWe used the Surveillance, Epidemiology, and End Results (SEER) database to identify individuals with a localised, histologically confirmed kidney/renal pelvis and ureteric UC. Survival analysis using the Kaplan-Meier method was performed. A competing risk model evaluated the cumulative incidence and predictors of cancer-specific mortality (CSM). ResultsWe identified 633 (7.6%) individuals who did not receive surgery. These individuals were significantly older (median age 81 vs 71 years, P < 0.001) than surgically managed patients. The median overall survival (OS) was significantly shorter compared to the surgical cohort (1.9 vs 7.8 years, P < 0.001). The 3-year disease-specific survival (DSS) for patients without surgery was significantly lower compared to those with surgery, at 73.7% vs 92.4%, respectively (P < 0.001). The 3-year DSS for patients with high-grade tumours was worse when compared to patients with low-grade tumours, at 65.1% vs 82.9%, respectively (P < 0.001). The 3-year cumulative CSM was 26.3%. On multivariable analysis, older age (hazard ratio [HR] 1.05, P < 0.001) and high tumour grade (HR 1.88, P < 0.001) were predictors of worse outcomes. ConclusionsIn this population-based cohort, 7.6% of patients with UTUC were managed with a non-definitive approach. The median OS for the untreated cohort was significantly shorter compared to the surgical cohort (1.9 vs 7.8 years, respectively). These data may be helpful in counselling patients who are poor surgical candidates, as non-definitive therapy may provide reasonable oncological outcomes.

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“…Treatment decision-making is guided by prognostic evaluation using tumor stage. As a matter of fact, non-metastatic and metastatic UTUCs require different management with different treatment goals: potentially curative and palliative, respectively [ 34 , 54 , 56 , 62 ].…”

Section: Treatment Managementmentioning

confidence: 99%

“…Metastatic UTUC treatment is primarily based on systemic chemotherapy as a palliative treatment [ 34 , 62 , 101 ]. Even in the presence of metastases, there is room for some surgical options.…”

Section: Treatment Managementmentioning

confidence: 99%

“…Current UTUC-specific evidence on systemic chemotherapy is growing, though bladder-cancer-related literature still plays a big role in supporting chemotherapy practices in UTUC patients. Chemotherapy should be offered to all patients with metastatic disease since cisplatin-based regimens can improve median survival, while single-agent and carboplatin-based combinations are less effective than cisplatin-based combination chemotherapy in terms of complete response and survival [ 62 , 64 , 101 , 105 ].…”

Section: Treatment Managementmentioning

confidence: 99%

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MicroRNA Signatures in the Upper Urinary Tract Urothelial Carcinoma Scenario: Ready for the Game Changer?

Cinque

Capasso

Vago

et al. 2022

IJMS

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Upper urinary tract urothelial carcinoma (UTUC) represents a minor subgroup of malignancies arising in the urothelium of the renal pelvis or ureter. The estimated annual incidence is around 2 cases per 100,000 people, with a mean age at diagnosis of 73 years. UTUC is more frequently diagnosed in an invasive or metastatic stage. However, even though the incidence of UTUC is not high, UTUC tends to be aggressive and rapidly progressing with a poor prognosis in some patients. A significant challenge in UTUC is ensuring accurate and timely diagnosis, which is complicated by the non-specific nature of symptoms seen at the onset of disease. Moreover, there is a lack of biomarkers capable of identifying the early presence of the malignancy and guide-tailored medical treatment. However, the growing understanding of the molecular biology underlying UTUC has led to the discovery of promising new biomarkers. Among these biomarkers, there is a class of small non-coding RNA biomarkers known as microRNAs (miRNAs) that are particularly promising. In this review, we will analyze the main characteristics of UTUC and focus on microRNAs as possible novel tools that could enter clinical practice in order to optimize the current diagnostic and prognostic algorithm.

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Upper tract urothelial carcinoma topical issue 2016: treatment of metastatic cancer

Abstract: The management of metastatic UTUC requires a multi-disciplinary approach. New insights from genomic profiling using targeted therapies, novel immunotherapies, and surgery represent promising avenues for further therapeutic exploration.

Cited by 8 publications

References 53 publications

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

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

Survival outcomes for patients with localised upper tract urothelial carcinoma managed with non‐definitive treatment

MicroRNA Signatures in the Upper Urinary Tract Urothelial Carcinoma Scenario: Ready for the Game Changer?

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