Advancements in the clinical management of upper tract urothelial carcinoma.

Introduction: Upper tract urothelial carcinoma (UTUC) remains a complex disease to manage given challenges in staging, surgical resection, use of perioperative therapy, and prevention of bladder recurrences. High level evidence is limited to guide management, however recent data has shifted treatment paradigms. We intend to review recent evidence on advancements in the clinical management for UTUC.Areas covered: This review summarizes advancements in pre-operative work-up, surgical technique, and the use of intravesical and systemic therapy in both the neoadjuvant and adjuvant settings. Special comment is made on progress in the genomics of UTUC and how that can inform clinical practice.Expert opinion: Advancements in the clinical management of UTUC are most prominently being made in the neoadjuvant chemotherapy setting. Although level I evidence is sparse, data from both single and multi-institutional retrospective samples strongly encourage the use of neoadjuvant chemotherapy especially in high-risk or advanced stage patients.

Expert review of anticancer therapy. 2019 Nov 26 [Epub ahead of print]

Jacob Taylor, Xiaosong Meng, Rashed Ghandour, Vitaly Margulis

Department of Urology, NYU Langone Health, New York, New York., Department of Urology, UT Southwestern Medical Center, Dallas, Texas.