UTUC Chemotherapy
INTRACOLLECTING SYSTEM THERAPY
The OLYMPUS trial of 110 patients looked at a temperature sensitive gel mixed with mitomycin (Jelmyto by UroGen URGN) that liquified as body temperature, providing a timed release of mitomycin C in the upper tract had encouraging results at 12mo follow up although did have a high rate of ureteral stricture. This drug was approved by FDA in April 2020. (2)
SYSTEMIC CHEMOTHERAPY
POUT trial shows adjuvant gemcitabine-cisplatin (gem-cis) or gem-carboplatin (if GFR 30-49) is beneficial. (6) Neoadjuvant chemotherapy retrospective studies have shown positive results, one of 240 people showing a 9% remission rate and a 46% reduction in prevalence of pT3 (1). A small study found adjuvant chemo after nephroureterectomy improved RFS without improvement in CSS or OS. (3) A phase II trial reported in 2020 showed neoadjuvant chemotherapy resulted in a 14% pathological complete response in their cohort of 30 patients. (4) A 2017 retrospective study of 1,035 patients found that patients with neoadjuvant were 30% less likely to die at 3 years. (5)
The OLYMPUS trial of 110 patients looked at a temperature sensitive gel mixed with mitomycin (Jelmyto by UroGen URGN) that liquified as body temperature, providing a timed release of mitomycin C in the upper tract had encouraging results at 12mo follow up although did have a high rate of ureteral stricture. This drug was approved by FDA in April 2020. (2)
SYSTEMIC CHEMOTHERAPY
POUT trial shows adjuvant gemcitabine-cisplatin (gem-cis) or gem-carboplatin (if GFR 30-49) is beneficial. (6) Neoadjuvant chemotherapy retrospective studies have shown positive results, one of 240 people showing a 9% remission rate and a 46% reduction in prevalence of pT3 (1). A small study found adjuvant chemo after nephroureterectomy improved RFS without improvement in CSS or OS. (3) A phase II trial reported in 2020 showed neoadjuvant chemotherapy resulted in a 14% pathological complete response in their cohort of 30 patients. (4) A 2017 retrospective study of 1,035 patients found that patients with neoadjuvant were 30% less likely to die at 3 years. (5)
- Liao, Ross S., et al. "Comparison of pathological stage in patients treated with and without neoadjuvant chemotherapy for high risk upper tract urothelial carcinoma." The Journal of urology 200.1 (2018): 68-73.
- Kleinmann, Nir, et al. "Primary chemoablation of low-grade upper tract urothelial carcinoma using UGN-101, a mitomycin-containing reverse thermal gel (OLYMPUS): an open-label, single-arm, phase 3 trial." The Lancet Oncology (2020).
- Song, Wan, et al. "Impact of adjuvant chemotherapy on oncologic outcomes following radical nephroureterectomy for patients with pT3NanyM0 upper tract urothelial carcinoma: A retrospective cohort study." International Journal of Surgery 66 (2019): 12-17.
- Margulis, Vitaly, et al. "Phase II Trial of Neoadjuvant Systemic Chemotherapy Followed by Extirpative Surgery in Patients with High Grade Upper Tract Urothelial Carcinoma." The Journal of Urology 203.4 (2020): 690-698.
- Seisen, Thomas, et al. "Efficacy of systemic chemotherapy plus radical nephroureterectomy for metastatic upper tract urothelial carcinoma." European urology 71.5 (2017): 714-718.
- Birtle, Alison Jane, et al. "Results of POUT: A phase III randomised trial of perioperative chemotherapy versus surveillance in upper tract urothelial cancer (UTUC)." (2018): 407-407.