Avoiding Kidney Removal Among Patients With UTUC Through Chemoablation

Recent data demonstrates kidney-sparing procedures are becoming the primary consideration in the treatment of low-grade upper tract urothelial carcinomas (UTUC).

“Although advances in our understanding of tumor histopathology have demonstrated that there are significant differences between low-grade UTUC and high-grade UTUC, the two disease states are often treated similarly,” explained authors.¹

Standard management of UTUC could include major surgical procedures, such as radical nephroureterectomy, which create the risk of short-term morbidity or potentially long-term decline in renal function.

Because low-grade UTUC is primarily diagnosed among patients aged older than 70 years,² therapy interventions replacing surgery or invasive procedures are often beneficial alternatives. The rare cancer develops slowly but can have damaging effects on quality of life, especially a kidney is removed, which can impact overall health including blood pressure and added risk for heart disease.

“Chemoablation may provide the ideal combination of low recurrence rates, acceptable short- and long-term safety, and tumor ablation without kidney removal,” said authors.¹

UTUC tends to reoccur, prompting the need for a high durability response to any kidney-sparing treatment. Per the National Comprehensive Cancer Network Bladder Guidelines,³ following initial evaluation, recommended treatment can include transurethral resection of bladder tumors, examination under anesthesia, imaging if not previously done, and intravesical chemotherapy dosing with either gemcitabine or mitomycin.

Jelmyto (mitomycin), approved by the FDA⁴ in April 2020 for adults with low-grade UTUC, is administered via a reverse-thermal hydrogel containing mitomycin, which is able to conform to patients’ complex renal anatomy when it warms. After 12 months, 70% of patients in the trial leading to fast-tracked FDA approval remained free of recurrence.^5,6

The recommended mitomycin dose is 4 mg per mL instilled via ureteral catheter or nephrostomy tube, with total instillation volume based on volumetric measurements using pyelography, not exceeding 15 mL (60 mg mitomycin), per an FDA press release.⁶

References:

1. Raman J, Shore ND. Management of Low-grade Upper Tract Urothelial Carcinoma: An Unmet Need. Rev Urol. 2020;22(1):1-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265178
2. Update on low-grade upper tract urothelial carcinoma. Everyday Urology – Oncology Insights. 2020;5(3). Accessed August 15, 2022. https://www.urotoday.com/journal/everyday-urology-oncology-insights/articles/125181-update-on-low-grade-upper-tract-urothelial-carcinoma.html
3. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Bladder Cancer, NCCN Evidence Blocks. Accessed August 15, 2022. https://www.nccn.org/professionals/physician_gls/pdf/bladder_blocks.pdf
4. US Food & Drug Administration. FDA approves mitomycin for low-grade upper tract urothelial cancer. April 15, 2020. Accessed August 16, 2020. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-mitomycin-low-grade-upper-tract-urothelial-cancer
5. Kleinmann N, Matin SF,  Pierorazio PM, et al. Primary chemoablation of low-grade upper tract urothelial carcinoma using UGN-101, a mitomycin-containing reverse thermal gel (OLYMPUS): an open-label, single-arm, phase 3 trial. Lancet Oncol. 2020;21(6):776-785. doi:10.1016/S1470-2045(20)30147-9
6. US Food and Drug Administration. JELMYTO™ (mitomycin) for pyelocalyceal solution. April 2020. Accessed August 16, 2022. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/211728s000lbl.pdf