Seth P. Lerner, MD, Professor of Urology and holder of the Beth and Dave Swalm Chair in Urologic Oncology in the Scott Department of Urology at Baylor University, provides an update on recent trials and treatment options for Upper Tract Urothelial Cancer (UTUC). He begins with the OLYMPUS study, outlines the rationale for neoadjuvant therapy, reviews ECOG’s EA8141 trial, and concludes with a discussion of adjuvant therapy.
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Seth P. Lerner, MD, Professor of Urology and holder of the Beth and Dave Swalm Chair in Urologic Oncology in the Scott Department of Urology at Baylor College of Medicine, discusses developments in upper tract urothelial carcinoma (UTUC) treatment. He delivers a rationale for adjuvant therapy based on a lack of clinical staging accuracy, a lack of high-level evidence to support perioperative systemic therapy, the perceived benefit in cases of high-risk bladder cancer, and the ability of pathologic staging to identify patients most likely to benefit. He then reviews the POUT trial of adjuvant chemotherapy, noting that it found a statistically significant benefit in disease-free survival and metastasis-free survival. Dr. Lerner continues by summarizing guideline statements. The EAU statement recommends perioperative chemo to patients with muscle invasive UTUC. ICUD states that it is unknown if adjuvant chemotherapy or waiting for the development of clinically evident disease is better. The French ccAFU recommends adjuvant chemotherapy after radical nephroureterectomy in pT2-T4 N0-3 M0 disease. Dr. Lerner then discusses neoadjuvant therapy, which studies suggest is beneficial to patients with optimized renal function. A Hopkins study specifically displayed a pathologic complete response of 9.4%, while the EA8141 trial found a total pathologic complete response of 13.8%. Dr. Lerner continues with a review of management options for low-grade UTUC, a rare disease with limited treatment options. He posits that a kidney-sparing treatment option is needed for patients, as there is a high chance of recurrence and kidney damage with the treatments currently available. Dr. Lerner theorizes that if durability of complete response following ablation with UGN-101 is demonstrated, this could provide a potential new kidney-sparing treatment for patients with low-grade UTUC. Dr. Lerner concludes with a discussion of the OLYMPUS study on UGN-101, which found a complete response in 59% of patients.
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Seth P. Lerner, MD, Professor of Urology, Director of Urologic Oncology and the Multidisciplinary Bladder Cancer Program, and Faculty Group Practice Medical Director for the Urology Clinic at Baylor College of Medicine discusses the impact of several upper tract urothelial carcinoma studies on the treatment of the disease. The POUT phase III trial used adjuvant therapy for high-risk patients who didn’t receive neoadjuvant therapy and through increased survival rates supported the establishment of the new adjuvant therapy standard of care. ECOG, a phase II trial of neoadjuvant systemic chemotherapy followed by extirpative surgery in high-risk upper tract urothelial carcinoma found about a 10% pathological complete response rate from treatment. QED, an ongoing adjuvant trial, tested infigratinib, an oral FGFR1-3 selective kinase inhibitor, so far finding increased survival rates in patients. Dr. Lerner concludes with the Olympus Study, a phase III prospective study on patients with low-grade disease in the renal pelvis using mitomycin gel for treatment and found a 58% complete response rate and led to the treatment’s approval by the FDA.
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Seth P. Lerner, MD, Professor of Urology at Baylor College of Medicine, reviews the results of the Optimized DeLivery of Mitomycin for Primary UTUC Study (OLYMPUS) trial, of which he was the principal investigator. In this study, a thermal, reversible gel was used as a kidney-sparing treatment of low-grade upper tract urothelial cancer (UTUC). He discusses the difficulty of managing UTUC, the function of UGN-101, and the dramatic results in patient outcomes from this trial.
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Seth P. Lerner, MD, provides the rationale for integrating perioperative chemotherapy and radical cystectomy, describes the evidence supporting neoadjuvant chemotherapy (NAC), and reviews the limited evidence supporting adjuvant therapy for patients with bladder cancer. He then discusses the future of predictive biomarkers and precision medicine in the management of this disease.
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