Expert Review on the Multidisciplinary Management of Bladder Cancer - Episode 3

Managing Renal Pelvis Transitional Cell Carcinoma

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The treatment of patients with renal pelvic tumors includes cystectomy and in high-risk disease potentially adjuvant chemotherapy, says Dean F. Bajorin, MD. Condcuting a nephroureterectomy, which results in the laparoscopic removal of the renal pelvis, kidney, bladder cuff, and the entire ureter, reduces an individual’s renal function by half but can improve outcomes. However, this approach results in a loss of opportunity to administer cisplatin-based therapy, explains Bajorin.

For patients with renal pelvic tumors, Evan Y. Yu, MD, suggests that prefers to enroll individuals into a clinical trial if available, rather than pursue immediate treatment. Outside of the clinical trial setting and surgery, there is a lack of clear definitive data suggesting an optimal approach. Ongoing clinical studies are assessing whether neoadjuvant chemotherapy confers survival benefit in this patient population.

A phase II study is assessing gemcitabine plus cisplatin as neoadjuvant therapy for patients with high-grade upper tract urothelial carcinoma, Bajorin notes. The study will assess time to progression and overall survival at 3 years as a secondary endpoint with the primary outcome measure focused on pathologic response rates (NCT01261728).