From the Desk of the Editor: 2019 Updates in Upper Tract Urothelial Carcinoma

Sam Chang | October 08, 2019

Throughout 2019, we have continued to see progress in the diagnosis, risk assessment and genetic profiling, and possible treatment of upper tract urothelial carcinoma (UTUC). I would like to highlight some of the most exciting findings reported so far this year.

Targetable mutations in UTUC: At the Fred Hutchinson Cancer Research Center and the University of Washington, Dr. Brian R. Winters, Dr. Andrew

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Sam S. Chang, MD, MBA, Patricia and Rodes Hart Endowed Professor of Urologic Surgery and Oncology, is the Oncology Fellowship Director and Vice-Chair of Urologic Surgery at Vanderbilt University Medical Center. His clinical practice focuses on urologic oncology and he has led numerous guideline panels in prostate, bladder and kidney cancer and formerly chaired the American Joint Committee on Cancer GU Staging Task Force. Author of more than 275 articles and recipient of multiple awards such as the SUO’s first-ever Distinguished Service Award, a CaPCURE Prostate Cancer Young Investigator Award, multiple Journal of Urology Best Reviewer, and the AUA Gold Cystoscope Award, he currently serves as Assistant Secretary of the AUA.

Library Resources
Evidence based monographs by experts to define and guide clinical practice
Written by Zachary Klaassen, MD, MSc and Christopher J.D. Wallis, MD, PhD
The urothelium lines the urinary tract from the renal pelvis to urethra. While cancers may arise anywhere along the urothelium, the vast majority (90-95%) occur in the lower urinary tract (bladder and urethra) while the remainder (5-10%) occur in the upper tract (ureter and renal pelvis)1.
Written by Zachary Klaassen, MD, MSc
Upper tract urothelial carcinoma, comprising either the renal pelvis or ureter, is rarer than urothelial carcinoma of the bladder accounting for only 5-10% of all urothelial carcinomas. However, similar to bladder urothelial carcinoma, 
Written by Christopher J.D. Wallis, MD, PhD
Upper tract urothelial carcinoma (UTUC) comprises any malignancies arising from the urothelium between the level of the renal pelvis and the distal ureter. Owing to their relatively rarity, there is generally little data to guide the management of patients with these tumors and much of practice is extrapolated from the management of urothelial cancer of the bladder.
Expert Commentary
Evidence based monographs by experts to define and guide clinical practice
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Although urothelial carcinomas of the bladder and upper tract urothelial carcinoma (UTUC) can have similar histology, they significantly differ in prevalence and risk factors.
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Upper tract urothelial carcinoma (UTUC) is a distinct clinical entity with poor clinical outcomes.
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Lynch Syndrome (LS) is a common hereditary cancer syndrome that is characterized by mutations in the mismatch repair (MMR) genes.
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Circulating tumor cells (CTCs) are cancer cells shed from the tumor that enter the circulation.
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Upper tract urothelial carcinoma is less common than bladder urothelial carcinoma. The biological characteristics of this form of the disease is not completely understood.
Upper Tract Urothelial Carcinoma Today
 
Curated content of advancements in upper tract urothelial carcinoma

Upper Tract Urothelial Carcinoma Today: 2019

Upper tract urothelial carcinoma (UTUC) comprises 5% to 10% of urothelial carcinomas, is distinct from bladder cancer, and often carries a worse prognosis — roughly 60% of patients present with invasive disease. Until recently, the relative rarity of UTUC and difficulties with accurate pre-operative staging impeded clinical trials and therapeutic progress.

Conference Coverage
Recent data from conferences worldwide
Presented by Chana Weinstock, MD
Washington, DC (UroToday.com) The expert panel of providers and FDA discussed ongoing and future collaborations with the FDA and bladder cancer. The FDA Oncology Center of Excellence (OCE) leverages the combined skills of regulatory scientists and reviewers. The panel reviewed the structure of the OCE and how expedited programs within the FDA strive to accelerate drug development and approval.
Presented by Seth Lerner, MD, FACS
Chicago, IL (UroToday.com) Low grade upper tract urothelial carcinoma (LG UTUC) can be managed with endoscopic resection/ablation however, the associated high recurrence rate requires repetitive intervention and intercavitary therapy for the frequently recurrent and multifocal disease.
Presented by Srikala (Kala) Sridhar, MD, MSc, FRCPC
Barcelona, Spain (UroToday.com)  Dr. Kala Sridhar, a medical oncologist from the University of Toronto, provided a summary of the current status of chemotherapy for upper tract urothelial carcinoma (UTUC).  UTUC accounts for 5-10% of urothelial malignancies, of which 60% are invasive at disease presentation. Radical nephroureterectomy remains the standard of care for localized and invasive disease.
Presented by Juan Palou, MD, PhD
Barcelona, Spain (UroToday.com) Upper tract urothelial carcinoma (UTUC) is a rare condition, making large clinical trials difficult to accrue for. More importantly, known concerns with the accuracy of pre-operative staging, and therefore, difficulties in accurately identifying high-risk patients...
Presented by Morgan Roupret, MD, Ph.D
Barcelona, Spain (UroToday.com) Upper tract urothelial carcinoma (UTUC) is a rare condition, making large clinical trials difficult to accrue for. More importantly, known concerns with the accuracy of pre-operative staging, and therefore, difficulties in accurately identifying high-risk patients make clinical trial accrual and accuracy difficult. As such, much of the data for UTUC is often extrapolated
Presented by Seth Paul Lerner, MD, FACS
San Francisco, CA (UroToday.com) -- UroGen Pharma Ltd., a clinical-stage biopharmaceutical company developing treatments to address unmet needs in the field of urology, with a focus on uro-oncology,  announced a new data presentation from an interim analysis of the ongoing pivotal Phase 3 OLYMPUS clinical trial of UGN-101 (MitoGel™),
Presented by Alison J. Birtle, MD, MRCP, FRCR
San Francisco, CA (UroToday.com) The management of patients with upper tract urothelial carcinoma (UTUC) is challenging due to the lack of high-level evidence, which results from the disease’s overall rarity. The standard of care for patients with high-grade disease or those suspected to have invasive disease is a radical nephroureterectomy,