Login to Access Video or Poster Abstract: MP78-02
Sources of Funding: Supported in part by the Monteleone Family Foundation for Research in Kidney and Bladder Cancer and the Eleanor and Scott Petty Fund for UTUC Research

Introduction

Topical therapy (TT) for UTUC has been explored as a kidney sparing approach to treat carcinoma in situ (CIS) and to decrease recurrence and progression for endoscopically treated Ta-1 tumors. In bladder cancer data supports use of 2nd line TT for repeat induction but this approach has yet to be investigated for UTUC. This study looks at outcomes following a 2nd line use of induction TT for UTUC in patients (Pts) ineligible for or refusing nephroureterectomy.

Methods

After IRB approval, charts of Pts receiving TT for UTUC from 3/2005-10/2016 at MD Anderson Cancer Center were retrospectively reviewed. Pts received TT via percutaneous nephrostomy tube or cystoscopically placed ureteral catheters per Pt choice. All Pts were offered induction and maintenance TT. Follow up was every 3 months with upper tract imaging or ureteroscopy (URS) in the 1st year and then at a minimum 6 mos interval. Pt outcomes were classified based upon recommendations outlined by the Intl. Bladder Cancer Group. Response after start of TT was defined as no evidence of disease after 6 mos, refractory cases as recurrence within 6 mos, and relapse as recurrence after 6 mos. Salvage TT was defined as therapy reinitiation following primary TT failure.

Results

51 Pts with 58 renal units (RUs) received TT. 55% (32/58) of RUs had low grade UTUC, 22% (13/58) had high grade UTUC, 17% (10/58) had CIS, and 5% (3/58) had unknown disease grade due to insufficient tissue but presumed low grade based on URS. Median follow up was 28.5 mos. 18 RUs received 2nd line TT, 8 (44%) as salvage therapy for refractory disease and 10 (56%) as re-induction for relapse or 1st line TT intolerance. Results of 2nd line TT and corresponding responses can be found in Table 1. 60% (6/10) with CIS responded to 1st line TT while 20% (1/5) with refractory/recurrent CIS responded to 2nd line TT. RUs receiving adjuvant TT had a 71% (34/48) response to 1st line TT and 62% (8/13) response to 2nd line TT both as salvage and reinduction.

Conclusions

Within the limitations of small subgroups, our data suggests that refractory/recurrent UTUC after 1st line adjuvant TT may be associated with response to a 2nd line agent. However, refractory/recurrent CIS was much less responsive to 2nd line TT. 2nd line TT is a potential salvage therapy for select Ta-1 tumors in those with limited treatment options.

Funding

Supported in part by the Monteleone Family Foundation for Research in Kidney and Bladder Cancer and the Eleanor and Scott Petty Fund for UTUC Research