scholarly journals Induction and Maintenance Adjuvant Mitomycin C Topical Therapy for Upper Tract Urothelial Carcinoma: Tolerability and Intermediate Term Outcomes

2017 ◽  
Vol 31 (9) ◽  
pp. 946-953 ◽  
Author(s):  
Michael Metcalfe ◽  
Gavin Wagenheim ◽  
Lianchun Xiao ◽  
John Papadopoulos ◽  
Neema Navai ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Mitomycin C ◽  
Topical Therapy ◽  
Upper Tract Urothelial Carcinoma ◽  
Upper Tract

Mitomycin-C induction and maintenance topical therapy for upper tract urothelial carcinoma

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 411-411 ◽  
Author(s):  
Gavin Neal Wagenheim ◽  
John Papadopolous ◽  
Neema Navai ◽  
John W. Davis ◽  
Jose A. Karam ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Mitomycin C ◽  
Topical Therapy ◽  
Percutaneous Nephrostomy ◽  
Low Grade ◽  
High Grade ◽  
Ureteral Catheter ◽  
Upper Tract ◽  
Endoscopic Control

411 Background: Reported recurrence rates following endoscopic treatment of upper tract urothelial carcinoma (UTUC) are high, from 30% to 70%. Adjuvant BCG topical therapy results are inferior to what is seen in adjuvant treatment of bladder cancer. This is likely due to difficulty in definitive delivery to the upper tract and the absence of a reservoir for dwell times. There is limited reported use of adjuvant mitomycin-c (MMC) for UTUC, and to our knowledge no reported experience of topical delivery using the SWOG maintenance regimen. We hypothesized that a chemotherapeutic agent may be effective topical therapy of the upper tract, particularly when given using SWOG recommendations. We report efficacy, safety, and tolerability of this approach. Methods: We reviewed charts of patients undergoing primary endoscopic biopsy/resection and ablation of an UTUC, recording clinical, pathologic, laboratory, and follow up information. Patients were offered induction and maintenance topical therapy after endoscopic control. MMC was given as initial adjuvant topical agent for 6 weeks induction and 3 weeks maintenance for up to 2 years per SWOG protocol. Delivery was either via percutaneous nephrostomy or ureteral catheter, per patient preference. Results: 28 patients were identified, 21 (75%) low grade and 7 (25%) high grade. Delivery of MMC was via percutaneous nephrostomy in 29% and ureteral catheter in 71%. 46% were treated on an imperative basis, 46% elective, and 7% palliative. No patients discontinued therapy due to intolerance, and 61% received maintenance. Only 11% of patients undergoing induction and 6% maintenance incurred complications. With a mean follow up of 22 months (range 1−79), recurrence-free, progression-free, and nephroureterectomy-free survival in all patients, low-grade patients, and high-grade patients was 68%, 67%, and 71%; 89%, 90%, and 86%; and 89%, 90%, and 86%, respectively. Conclusions: In patients with complete endoscopic control, upper tract topical instillation of MMC induction and maintenance via percutaneous nephrostomy or ureteral catheter is a well−tolerated, feasible, and perhaps beneficial treatment of low-grade and possibly high-grade tumors.

scholarly journals Salvage topical therapy for upper tract urothelial carcinoma

2018 ◽  
Vol 36 (12) ◽  
pp. 2027-2034
Author(s):  
Adithya Balasubramanian ◽  
Michael J. Metcalfe ◽  
Gavin Wagenheim ◽  
Lianchun Xiao ◽  
John Papadopoulos ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Topical Therapy ◽  
Upper Tract Urothelial Carcinoma ◽  
Upper Tract

scholarly journals Thermo Reversible Hydrogel Based Delivery of Mitomycin C (UGN-101) for Treatment of Upper Tract Urothelial Carcinoma (UTUC)

2019 ◽  
Vol 5 (1) ◽  
pp. 21-29 ◽  
Author(s):  
Nir Kleinmann ◽  
Gregory Wirth ◽  
Jeffrey S. Lin ◽  
Surena F. Matin ◽  
Ofer Nativ ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Mitomycin C ◽  
Upper Tract Urothelial Carcinoma ◽  
Upper Tract

scholarly journals UGN-101 (mitomycin gel): a novel treatment for low-grade upper tract urothelial carcinoma

2020 ◽  
Vol 12 ◽  
pp. 175883592093795
Author(s):  
Andrea Kokorovic ◽  
Surena F. Matin
Keyword(s):  
Urothelial Carcinoma ◽  
Mitomycin C ◽  
Unmet Need ◽  
Invasive Disease ◽  
Upper Tract Urothelial Carcinoma ◽  
Phase Iii ◽  
Low Grade ◽  
Upper Tract ◽  
Carcinoma Of The Bladder ◽  
Rare Malignancy

Upper tract urothelial carcinoma (UTUC) is a rare malignancy. The standard treatment for localized high-risk disease is radical nephroureterectomy, which confers significant morbidity and is not appropriate for all patients. Patients harboring low-risk, non-invasive disease may be candidates for organ-sparing treatment, which includes endoscopic resection with or without intracavitary drug therapy. Successful administration of intracavitary chemotherapy to the upper tracts is impeded by rapid washout of the agent and short dwell times. This has limited the clinical utility of mitomycin C for treatment of upper tract tumors, despite the successful outcomes observed in low-grade urothelial carcinoma of the bladder. Currently, there is an unmet need for development of a technically feasible and oncologically sound intracavitary therapy for management of low-grade UTUC. UGN-101 (Jelmyto™) is a novel formulation of mitomycin C that uses a unique hydrogel designed to increase urinary dwell time, and thereby efficacy of treatment. Preclinical data demonstrated promising results regarding the safety and feasibility of this agent. Preliminary results of a phase III trial (OLYMPUS study) [ClinicalTrials.gov identifier: NCT02793128] demonstrated the efficacy of UGN-101 as a successful chemo-ablative agent for low-grade upper tract tumors. UGN-101 may represent a pivotal paradigm shift in the treatment of low-grade UTUC. Indeed, the drug has recently been granted approval by the US Food and Drug Administration as the first treatment for low-grade UTUC, which may lead to significant improvements in patient care and a long-awaited decrease in the burden of disease.

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