M N Pham1, A B Apolo2, M De Santis3, M D Galsky4, B C Leibovich5, L L Pisters6, A O Siefker-Radtke6, G Sonpavde7, G D Steinberg8, C N Sternberg9, S T Tagawa10, A Z Weizer11, M E Woods12, M I Milowsky13. 1. University of North Carolina School of Medicine, Chapel Hill, NC, USA. 2. National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. 3. Cancer Research Unit, University of Warwick, Coventry, UK. 4. The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 5. Department of Urology, Mayo Clinic, Rochester, MN, USA. 6. University of Texas MD Anderson Cancer Center, Houston, TX, USA. 7. University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL, USA. 8. Section of Urology, Department of Surgery, The University of Chicago Medical Center, Chicago, IL, USA. 9. San Camillo and Forlanini Hospitals, Rome, Italy. 10. Weill Cornell Medicine, New York, NY, USA. 11. Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, MI, USA. 12. Department of Urology, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA. 13. Division of Hematology/Oncology, Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, 3rd Floor Physician's Office Building, 170 Manning Drive, Chapel Hill, NC, 27599, USA. matt_milowsky@med.unc.edu.
Abstract
PURPOSE: To review the management of metastatic upper tract urothelial carcinoma (UTUC) including recent advances in targeted and immune therapies as an update to the 2014 joint international consultation on UTUC, co-sponsored by the Société Internationale d'Urologie and International Consultation on Urological Diseases. METHODS: A PubMed database search was performed between January 2013 and May 2016 related to the treatment of metastatic UTUC, and 54 studies were selected for inclusion. RESULTS: The management of patients with metastatic UTUC is primarily an extrapolation from evidence guiding the management of metastatic urothelial carcinoma of the bladder. The first-line therapy for metastatic UTUC is platinum-based combination chemotherapy. Standard second-line therapies are limited and ineffective. Patients with UTUC who progress following platinum-based chemotherapy are encouraged to participate in clinical trials. Recent advances in genomic profiling present exciting opportunities to guide the use of targeted therapy. Immunotherapy with checkpoint inhibitors has demonstrated extremely promising results. Retrospective studies provide support for post-chemotherapy surgery in appropriately selected patients. CONCLUSIONS: 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.
PURPOSE: To review the management of metastatic upper tract urothelial carcinoma (UTUC) including recent advances in targeted and immune therapies as an update to the 2014 joint international consultation on UTUC, co-sponsored by the Société Internationale d'Urologie and International Consultation on Urological Diseases. METHODS: A PubMed database search was performed between January 2013 and May 2016 related to the treatment of metastatic UTUC, and 54 studies were selected for inclusion. RESULTS: The management of patients with metastatic UTUC is primarily an extrapolation from evidence guiding the management of metastatic urothelial carcinoma of the bladder. The first-line therapy for metastatic UTUC is platinum-based combination chemotherapy. Standard second-line therapies are limited and ineffective. Patients with UTUC who progress following platinum-based chemotherapy are encouraged to participate in clinical trials. Recent advances in genomic profiling present exciting opportunities to guide the use of targeted therapy. Immunotherapy with checkpoint inhibitors has demonstrated extremely promising results. Retrospective studies provide support for post-chemotherapy surgery in appropriately selected patients. CONCLUSIONS: 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.
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Authors: Neeraj Agarwal; Joaquim Bellmunt; Benjamin L Maughan; Kenneth M Boucher; Toni K Choueiri; Angela Q Qu; Nicholas J Vogelzang; Ronan Fougeray; Guenter Niegisch; Peter Albers; Yu-Ning Wong; Yoo-Joung Ko; Srikala S Sridhar; Srinivas K Tantravahi; Matthew D Galsky; Daniel P Petrylak; Ulka N Vaishampayan; Amitkumar N Mehta; Tomasz M Beer; Cora N Sternberg; Jonathan E Rosenberg; Guru Sonpavde Journal: Clin Genitourin Cancer Date: 2013-09-28 Impact factor: 2.872
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