Urology News and Education Resource
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Thursday, 28 March 2024 |
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Systemic Therapies in Upper Tract Urothelial Carcinoma
Srikala (Kala) Sridhar MD, MSc, FRCPC
Kala Sridhar provides a state-of-the-state in the contemporary understanding of upper tract disease, recent clinical trial findings and the impact of those trials on clinical practice treatment.
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The Diagnostic and Therapeutic Challenges Associated with UTUC
Sam S. Chang, MD, MBA
Alicia Morgans and Sam Chang discuss the diagnostic and therapeutic challenges of upper tract urothelial carcinoma (UTUC). Dr. Chang highlights the use of CT urograms in the diagnosis and how size, grade, and stage of the tumor is used to inform treatment decisions, balancing renal preservation with oncologic treatment.
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SAUL Trial Data: Real World Experience of Atezolizumab in Carcinomas of the Urinary Tract
Cora Sternberg MD, FACP
Cora Sternberg and Alicia Morgans discuss the SAUL (A Study of Atezolizumab in Locally Advanced or Metastatic Urothelial or Non-Urothelial Carcinoma of the Urinary Tract) trial data which represents the "real world" experience with atezolizumab for the treatment of carcinomas of the urinary tract. The SAUL study enrolled patients that typically would be excluded from clinical trials including those patients with poor renal function, patients on dialysis, patients with immune disorders and poor performance status.
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Nephron-sparing Management of Low Grade UTUC with UGN-101 for Instillation: The Olympus Trial Experience
Seth Lerner, MD, FACS
Seth Lerner presented positive findings from the secondary analysis from the phase 3 OLYMPUS trial of UGN-101 for patients with low grade upper tract urothelial carcinoma. Low grade upper tract urothelial carcinoma 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. This was a single arm prospective phase 3 open-label study in patients with low grade UTUC. The primary objective was to evaluate the safety and tumor ablative effect of UGN-101.
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Challenges of Therapy in Upper-Tract Urothelial Carcinoma
Dr. Matin, a Urologic Oncologist at The University of Texas MD Anderson Cancer Center, Houston, presented on challenges of therapy in upper-tract urothelial carcinoma (UTUC). He started his talk with current challenges in the management of UTUC which includes risk stratification, endoscopic management, renal dysfunction, neoadjuvant and adjuvant chemotherapy, and lymph node dissection.
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High-grade Upper Tract Urothelial Carcinoma – Neoadjuvant Chemotherapy
Dr. Kala Sridhar participated in a debate and supported the use of neoadjuvant chemotherapy instead of adjuvant chemotherapy for high-grade upper tract urothelial carcinoma (UTUC). UTUC is a rare disease involving the renal pelvis and ureter. High-grade disease is usually treated with radical nephroureterectomy, with a 5-year cancer-specific survival of less than 50% for pT3 disease, 5-10% for pT4 disease, and less than 35% for the pN+ disease. Perioperative chemotherapy plays an important role in the treatment of this high-grade disease.
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Phase III Trial of Intravenous Mannitol Versus Placebo During Nephron Sparing Surgery: 3-Year Outcomes
Dr. Nathan C. Wong presented on the use of mannitol for nephron-sparing surgery. Dr. Wong began by referring to previous literature in which retrospective analysis showed no significant difference in eGFR between a patient who were given mannitol versus those who were not given mannitol. In the following study, Dr. Wong evaluates these shortcomings by including a thorough interaction analysis of the previous paper’s original data with a longer-term follow-up.
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Active Surveillance vs. Nephron Sparing Surgery for Small Renal Mass in Very Elderly Patients: A Competing Risk Analysis
Active surveillance for small renal masses has become an established first-line treatment option based on growing evidence of the indolent natural history of the majority of these lesions. Yet, the uptake for AS has been quite low. In this study, authors from multiple international centers address the question of AS vs. nephron-sparing surgery for small renal masses and specifically look at competing risks of death. A purpose built a multi-institutional international database (REnal SURGery in the Elderly - RESURGE project) was used for this retrospective analysis.
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