Abstract
Objective
Urothelial cell carcinoma
of the upper urinary tract (UUT-UCC) is a rare, aggressive urologic
cancer with a propensity for multifocality, local recurrence, and
metastasis. This review highlights the main chemotherapy regimens
available for UUT-UCCs based on the recent literature.
Materials and methods
Data
on urothelial malignancies and UUT-UCCs management in the literature
were searched using MEDLINE and by matching the following key words:
urinary tract cancer; urothelial carcinomas; upper urinary tract;
carcinoma; transitional cell; renal pelvis; ureter; bladder cancer;
chemotherapy; nephroureterectomy; adjuvant treatment; neoadjuvant
treatment; recurrence; risk factors; and survival.
Results
No
evidence level 1 information from prospective randomized trials was
available. Because of its many similarities with bladder urothelial
carcinomas, chemotherapy with a cisplatin-containing regimen is often
proposed in patients with metastatic or locally advanced disease. Most
teams have proposed a neoadjuvant or an adjuvant treatment based either
on the combination of methotrexate, vinblastine, adriamycin, and
cisplatin (MVAC) or on gemcitabine/cisplatin (GC). These regimens have
been shown to prolong survival moderately. All recent studies have
included limited numbers of patients and have reported poor patient
outcomes after both neoadjuvant and adjuvant chemotherapy. Regarding
metastatic UUT-UCCs, vinflunine has demonstrated moderate activity in
these patients with a manageable toxicity. Interestingly, specific
molecular markers [microsatellite instability (MSI), E-cadherin, HIF-1α,
and RNA levels of the telomerase gene] can provide useful information
that can help diagnose and determine patient prognosis in patients with
UUT-UCC.
Conclusion
Chemotherapy
with a cisplatin-containing regimen is often proposed in patients with
metastatic or locally advanced disease. However, there is no strong
evidence that chemotherapy is effective due to the rarity of the disease
and the lack of data in the current literature. Thus, physicians must
take into account the specific clinical characteristics of each
individual patient with regard to renal function, medical comorbidities,
tumor location, grade, and stage, and molecular marker status when
determining the optimal treatment regimen for their patients. The
ongoing identification of the oncologic mechanisms of this type of
cancer might pave the way for the development of specific treatments
that are targeted to the characteristics of each patient's tumor in the
future.
