Updates in Upper Tract Urothelial Cancer

Posted by Seth P. Lerner, MD | Jun 2021

Seth P. Lerner, MD, moderated “Updates in Upper Tract Urothelial Cancer” during the International Bladder Cancer Update 2021 virtual conference in April 2021.

How to cite: Lerner, Seth P. “Updates in Upper Tract Urothelial Cancer” April 2021. Accessed Apr 2024. https://grandroundsinurology.com/updates-in-upper-tract-urothelial-cancer/

Updates in Upper Tract Urothelial Cancer – Summary:

Seth P. Lerner, MD, Professor of Urology and holder of the Beth and Dave Swalm Chair in Urologic Oncology in the Scott Department of Urology at Baylor University, provides an update on recent trials and treatment options for upper tract urothelial cancer (UTUC). He begins with the OLYMPUS study, a phase III prospective study assessing treatment of low-grade disease with mitomycin gel, which found a complete response in 59% of patients. Dr. Lerner then outlines the rationale for neoadjuvant therapy, which is based, in part, on level 1 evidence for patients with muscle invasive bladder cancer, adding that it can help identify patients at increased risk for locally advanced or micrometastatic disease. Newer data shows a lower pathological stage in patients who were treated with neoadjuvant chemotherapy than patients treated without. He notes that the EAU recently updated its guidelines to strongly recommend adjuvant chemotherapy. Dr. Lerner reviews ECOG’s EA8141, a prospective phase II trial of neoadjuvant chemotherapy followed by surgery in high-risk UTUC, which found roughly a 14% overall pathological complete response rate after treatment. He then comments on Lynch Syndrome and the approval of Pembrolizumab for patients with unresectable or metastatic MSI high or MMR deficient solid tumors. This treatment should be considered in patients with a solitary kidney. Dr. Lerner concludes with a discussion of adjuvant therapy including an overview of the POUT trial.

About the International Bladder Cancer Update 2021 virtual conference:
The International Bladder Cancer Update (IBCU) is a CME conference focused on the diagnosis and treatment of bladder cancer. The conference offers medical professionals an opportunity to listen to updates from, and interact with, expert international faculty to improve knowledge and determine best treatment practices to improve patient outcomes. IBCU encompasses expert lectures, interactive discussions, a panel roundtable, debates, and case presentations. It is physician-led, multi-supported, and designed for urologists, urologic oncologists, and other healthcare professionals involved in the treatment of bladder cancer.

About The Author

Seth P. Lerner, MD

Seth P. Lerner, MD, is Professor of Urology and Vice-Chair for Faculty Affairs in the Scott Department of Urology at the Baylor College of Medicine in Houston, Texas. He holds the Beth and Dave Swalm Chair in Urologic Oncology. Dr. Lerner is the Director of Urologic Oncology and the Multidisciplinary Bladder Cancer Program, also at Baylor. Dr. Lerner earned his medical degree from the Baylor College of Medicine, completed a surgical internship at Virginia Mason Hospital in Seattle, and returned to Baylor for his residency training. He completed a two-year fellowship at the University of Southern California in Urologic Oncology and Reconstructive Surgery and joined the full-time Baylor faculty in 1992. Dr. Lerner’s clinical practice, education, and research activities are devoted to urologic oncology, particularly to lower and upper tract urothelial cancer. Dr. Lerner is the author of 228 peer-reviewed articles, co-editor of a comprehensive Textbook on Bladder Cancer, and founding co-editor-in-chief of the Bladder Cancer journal. His research interests include the use of selective estrogen receptor modulators for treatment of bladder cancer, gene therapy, integrated proteogenomic analysis of bladder and upper urinary tract cancers, and outcomes of radical cystectomy and pelvic lymphadenectomy. Dr. Lerner has 30 years of experience as a clinical investigator for both National Cancer Institute (NCI) and industry-funded clinical trials. He is Principal Investigator of the ongoing SWOG NCI Phase III trial comparing extended vs. standard pelvic lymphadenectomy at time of radical cystectomy. He is active in the leadership of several national bladder cancer research enterprises, serving as chair of the Local Bladder Cancer committee of SWOG, founding and former co-chair of the NCI Bladder Cancer Task Force, and former co-chair of theNCI National Clinical Trials Network (NCTN) Genitourinary Steering Committee. He co-chaired the Analysis Working Group of The Cancer Genome Atlas Project for muscle invasive bladder cancer and was recently appointed to a 4-year term to the NCI Clinical Trials and Translational Research Advisory Committee. Dr. Lerner is very active in the Bladder Cancer Advocacy Network (BCAN) as a member of the Board of Directors, is past chair of the Bladder Cancer Think Tank, and is co-chair of the management committee of the Bladder Cancer Research Network. Dr. Lerner is an active member of the prestigious American Association of Genitourinary Surgeons and is listed routinely among “America’s Top Doctors” and “Best Doctors in America.”

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