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

World Journal of Urology volume 35, pages 367–378 (2017)Cite this article

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.

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Author contributions

MN Pham: Data collection and management, data analysis, manuscript writing/editing; AB Apolo, M De Santis, MD Galsky, BC Leibovich, LL Pisters, AO Siefker-Radtke, G Sonpavde, GD Steinberg, CN Sternberg, ST Tagawa, AZ Weizer and ME Woods: Data analysis, manuscript writing/editing; MI Milowsky: Project development, data collection and management, data analysis, manuscript writing/editing.

Funding

None.

Author information

Affiliations

  1. University of North Carolina School of Medicine, Chapel Hill, NC, USA

    M. N. Pham

  2. National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    A. B. Apolo

  3. Cancer Research Unit, University of Warwick, Coventry, UK

    M. De Santis

  4. The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    M. D. Galsky

  5. Department of Urology, Mayo Clinic, Rochester, MN, USA

    B. C. Leibovich

  6. University of Texas MD Anderson Cancer Center, Houston, TX, USA

    L. L. Pisters & A. O. Siefker-Radtke

  7. University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL, USA

    G. Sonpavde

  8. Section of Urology, Department of Surgery, The University of Chicago Medical Center, Chicago, IL, USA

    G. D. Steinberg

  9. San Camillo and Forlanini Hospitals, Rome, Italy

    C. N. Sternberg

  10. Weill Cornell Medicine, New York, NY, USA

    S. T. Tagawa

  11. Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, MI, USA

    A. Z. Weizer

  12. Department of Urology, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA

    M. E. Woods

  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

    M. I. Milowsky

Authors
  1. M. N. Pham
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  2. A. B. Apolo
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  3. M. De Santis
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  4. M. D. Galsky
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  5. B. C. Leibovich
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  6. L. L. Pisters
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  7. A. O. Siefker-Radtke
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  8. G. Sonpavde
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  9. G. D. Steinberg
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  10. C. N. Sternberg
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  11. S. T. Tagawa
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  12. A. Z. Weizer
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  13. M. E. Woods
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  14. M. I. Milowsky
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Correspondence to M. I. Milowsky.

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Conflict of interest

MN Pham, AB Apolo, BC Leibovich, LL Pisters, AZ Weizer, ME Woods have no conflicts of interest. M De Santis has received research funding from Pierre Fabre Oncology and honoraria and consultation fees from Amgen, Astellas, Bayer, Celgene, Dendreon, Eisai Inc., ESSA, Ferring, GSK, Janssen Cilag, Merck, Novartis, Pfizer, Pierre Fabre Oncology, Roche, Sanofi Aventis, Shionogi, Synthon, Takeda and Teva/OncoGenex; MD Galsky has received research funding (to institution) from Merck, Genentech, BMS, Celgene, Novartis, and Dendreon. He is a member of the advisory boards for Merck, Genentech, and Novartis; AO Siefker-Radtke is a consultant and scientific advisor for: AstraZeneca, Genentech, Janssen, Eisai, and Merck. She receives research funding (to institution) from Millenium/Takeda, Genentech, Janssen, and AstraZeneca; G Sonpavde receives research support from Onyx, Bayer, Merck, Celgene, Pfizer, and Boehringer-Ingelheim. He is on the advisory board and/or is a consultant for Merck, Genentech, Sanofi, Bayer, Pfizer, Agensys, Novartis, and Argos. He is an author for UpToDate and speaker for Clinical Care Options; GD Steinberg is a consultant, scientific advisor, and/or investigator for: Photocure, Taris Biomedical, Cold Genesys, Heat Biologics, Roche/Genentech, UroGen, Merck, Karl Storz, and Telesta; CN Sternberg is a consultant, scientific advisor, and/or investigator for Merck, BMS, Oncogenex, and Lilly; ST Tagawa has received honoraria from Sanofi, Astellas, Janssen, Dendreon, Bayer, and Genentech and research funding (to institution) from Sanofi, Astellas, Janssen, Genentech, Lilly, Dendreon, Progenics, Millennium, Amgen, Bayer, Rexahn, and Inovio; MI Milowsky has received research funding (to institution) from BIND Therapeutics, Dendreon, Exelixis, Johnson & Johnson, Mirati Therapeutics, Pfizer, Cerulean Pharma, Merck, Seattle Genetics, Acerta Pharma, BioClin Therapeutics, and Roche/Genentech.

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Pham, M.N., Apolo, A.B., De Santis, M. et al. Upper tract urothelial carcinoma topical issue 2016: treatment of metastatic cancer. World J Urol 35, 367–378 (2017). https://doi.org/10.1007/s00345-016-1885-4

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  • DOI: https://doi.org/10.1007/s00345-016-1885-4

Keywords

  • Upper tract urothelial carcinoma (UTUC)
  • Chemotherapy
  • Targeted therapy
  • Immunotherapy
  • Anti-PD-1
  • Anti-PD-L1
  • Immune checkpoint inhibitors