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Morgan Rouprêt - One of the best experts on this subject based on the ideXlab platform.
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Consultation on UTUC, Stockholm 2018 aspects of risk stratification: long-term results and follow-up
World Journal of Urology, 2019Co-Authors: Mudhar Hasan, Morgan Rouprêt, Francis Keeley, Cecilia Cracco, Robert Jones, Michael Straub, Olivier Traxer, Palle Jörn Sloth Osther, Marianne BrehmerAbstract:PURPOSE : To summarize current knowledge on upper Urinary Tract Carcinoma (UTUC) regarding risk stratification, long-term results, and follow-up. METHODS : A scoping review approach was applied to search literature in Pubmed, Web of Science, and Embase. Consensus was reached through discussions at Consultation on UTUC, September 2018, Stockholm. RESULTS : To optimize oncological outcome considering both cancer-specific survival (CSS) and overall survival (OS), it is essential to identify pre- and postoperative prognostic factors. In low-risk UTUC, kidney-sparing surgery (KSS) and radical nephroureterectomy (RNU) offer equivalent CSS, whereas RNU may result in poorer OS due to nephron loss. For more aggressive tumours, undergrading can lead to insufficient treatment. The strongest prognostic factors are tumour stage and grade. Determining grade is best achieved by ureterorenoscopy (URS) with focal samples, biopsy and cytology. Staging is more difficult but can be indirectly achieved by multiphase computed tomography urography (CTU) or tumour grade determined by cytology and histopathology. Patients treated with KSS should be monitored closely with regular follow-ups (URS and CTU). CONCLUSION : KSS should be offered in low-risk UTUC when feasible, whereas RNU is the treatment of choice in organ-confined high-risk UTUC. Intravesical recurrence (IVR) is common after RNU, but a single postoperative dose of mitomycin instillation decreases IVR. Endourological management has high local and bladder recurrence rates; however, its effect on CSS or overall survival OS is unclear. RNU is associated with significant risk of chronic kidney disease. Careful selection of patients and risk stratification are mandatory, and patients should be followed according to strict protocols.
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european association of urology guidelines on upper Urinary Tract urothelial cell Carcinoma 2015 update
European Urology, 2015Co-Authors: Morgan Rouprêt, Richard Zigeuner, Richard Sylvester, Marko Babjuk, Eva Comperat, Maximilian Burger, Nigel C Cowan, Paolo Gontero, Bas W G Van Rhijn, Hugh A MostafidAbstract:AbsTract Context The European Association of Urology (EAU) guidelines panel on upper Urinary Tract urothelial cell Carcinoma (UTUC) has prepared updated guidelines to aid clinicians in the current evidence-based management of UTUC and to incorporate recommendations into clinical practice. Objective To provide a brief overview of the EAU guidelines on UTUC as an aid to clinicians. Evidence acquisition The recommendations provided in the current guidelines are based on a thorough review of available UTUC guidelines and articles identified following a systematic search of Medline. Data on urothelial malignancies and UTUC were searched using these keywords: Urinary Tract cancer; urothelial Carcinomas; upper Urinary Tract, Carcinoma; renal pelvis; ureter; bladder cancer; chemotherapy; nephroureterectomy; adjuvant treatment; instillation; neoadjuvant treatment; recurrence; risk factors; and survival. References were weighted by a panel of experts. Evidence synthesis Due to the rarity of UTUC, there are insufficient data to provide strong recommendations (ie, grade A). However, the results of recent multicentre studies are now available, and there is a growing interest in UTUC. The 2009 TNM classification is recommended. Recommendations are given for diagnosis and risk stratification as well as radical and conservative treatment, and prognostic factors are discussed. A single postoperative dose of intravesical mitomycin after nephroureterectomy reduces the risk of bladder tumour recurrence. Recommendations are also provided for patient follow-up after different therapeutic strategies. Conclusions These guidelines contain information on the management of individual patients according to a current standardised approach. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen, based on the proposed risk stratification of these tumours. Patient summary Urothelial Carcinoma of the upper Urinary Tract is rare, but because 60% of these tumours are invasive at diagnosis, an appropriate diagnosis is most important. A number of known risk factors exist.
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european association of urology guidelines on upper Urinary Tract urothelial cell Carcinoma 2015 update
European Urology, 2015Co-Authors: Morgan Rouprêt, Richard Zigeuner, Richard Sylvester, Marko Babjuk, Eva Comperat, Maximilian Burger, Nigel C Cowan, Paolo Gontero, Bas W G Van Rhijn, Hugh A MostafidAbstract:AbsTract Context The European Association of Urology (EAU) Guidelines Panel on Upper Urinary Tract Urothelial Carcinoma (UTUC) has prepared updated guidelines to aid clinicians in the current evidence-based management of UTUC and to incorporate recommendations into clinical practice. Objective To provide an overview of the EAU guidelines on UTUC as an aid to clinicians. Evidence acquisition The recommendations provided in the current guidelines are based on a thorough review of available UTUC guidelines and articles identified following a systematic search of Medline. Data on urothelial malignancies and UTUC were searched using the following keywords: Urinary Tract cancer; urothelial Carcinomas; upper Urinary Tract, Carcinoma; renal pelvis; ureter; bladder cancer; chemotherapy; ureteroscopy; nephroureterectomy; adjuvant treatment; instillation; recurrence; risk factors; and survival. References were weighted by a panel of experts. Evidence synthesis Owing to the rarity of UTUC, there are insufficient data to provide strong recommendations (ie, grade A). However, the results of recent multicentre studies are now available, and there is a growing number of retrospective articles in UTUC. The 2017 tumour, node, metastasis (TNM) classification is recommended. Recommendations are given for diagnosis and risk stratification, as well as for radical and conservative treatment; prognostic factors are also discussed. A single postoperative dose of intravesical mitomycin after radical nephroureterectomy reduces the risk of bladder tumour recurrence. Kidney-sparing management should be offered as a primary treatment option to patients with low-risk tumours and two functional kidneys. Conclusions These guidelines contain information on the management of individual patients according to a current standardised approach. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen, based on the proposed risk stratification of these tumours. Patient summary Urothelial Carcinoma of the upper Urinary Tract is rare, but because 60% of these tumours are invasive at diagnosis; appropriate diagnosis and management is most important. We present recommendations based on current evidence for optimal management.
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the role of chemotherapy in the treatment of urothelial cell Carcinoma of the upper Urinary Tract uut ucc
Urologic Oncology-seminars and Original Investigations, 2013Co-Authors: Francois Audenet, Olivier Cussenot, David R Yates, Morgan RouprêtAbstract: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.
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european guidelines for the diagnosis and management of upper Urinary Tract urothelial cell Carcinomas 2011 update
Actas Urologicas Espanolas, 2012Co-Authors: Morgan Rouprêt, Richard Zigeuner, Joan Palou, Andreas Boehle, E Kaasinen, Richard Sylvester, Marko Babjuk, Willem OosterlinckAbstract:AbsTract Context The European Association of Urology (EAU) Guideline Group for urothelial cell Carcinoma of the upper Urinary Tract (UUT-UCC) has prepared new guidelines to aid clinicians in assessing the current evidence-based management of UUT-UCC and to incorporate present recommendations into daily clinical practice. Objective This paper provides a brief overview of the EAU guidelines on UUT-UCC as an aid to clinicians in their daily practice. Evidence acquisition The recommendations provided in the current guidelines are based on a thorough review of available UUT-UCC guidelines and papers identified using a systematic search of Medline. Data on urothelial malignancies and UUT-UCCs in the literature were searched using Medline with the following keywords: 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. A panel of experts weighted the references. Evidence synthesis There is a lack of data in the current literature to provide strong recommendations due to the rarity of the disease. A number of recent multicentre studies are now available, whereas earlier publications were based only on limited populations. However, most of these studies have been retrospective analyses. The 2009 TNM classification is recommended. Recommendations are given for diagnosis as well as for radical and conservative treatment; prognostic factors are also discussed. Recommendations are provided for patient follow-up after different therapeutic options. Conclusions These guidelines contain information for the diagnosis and treatment of individual patients according to a current standardised approach. When determining the optimal treatment regimen, physicians must take into account each individual patient's specific clinical characteristics with regard to renal function including medical comorbidities, tumour location, grade and stage, and molecular marker status.
Guru Sonpavde - One of the best experts on this subject based on the ideXlab platform.
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an open label multicenter phase iiib study of patients with Urinary Tract Carcinoma utc strong final analysis for fixed dose durvalumab monotherapy module a
Journal of Clinical Oncology, 2021Co-Authors: Guru Sonpavde, Yohann Loriot, Cora N Sternberg, Aurelien Marabelle, Jaelyun Lee, Aude Flechon, Guilhem Roubaud, Damien Pouessel, Vittorina Zagonel, Fabio CalabroAbstract:429Background: Patients (pts) with advanced UTC who fail first-line therapy have poor prognoses. Durvalumab (D; anti-PD-L1) 10 mg/kg every 2 weeks is approved for treatment of metastatic urothelial...
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an open label multicenter phase iiib study of patients with Urinary Tract Carcinoma utc strong interim safety results for fixed dose durvalumab d monotherapy module a
Journal of Clinical Oncology, 2020Co-Authors: Guru Sonpavde, Paulo Miranda, Cora N Sternberg, Jaelyun Lee, Ana Rita Lima, Makan Sarkeshik, Sebastien J HotteAbstract:484Background: Patients (pts) with advanced UTC who fail first-line therapy have a poor prognosis and limited treatment options, with only modest benefit from chemotherapy. D (anti-PD-L1 antibody) ...
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a phase 3b safety study of fixed dose durvalumab tremelimumab or durvalumab monotherapy in advanced solid malignancies strong urothelial and non urothelial Urinary Tract Carcinoma module a
Journal of Clinical Oncology, 2018Co-Authors: Guru Sonpavde, Solange Peters, Luke T Nordquist, Terufumi Kato, Paulo Miranda, Qin Wang, Mark A SocinskiAbstract:TPS538Background: Despite initial high response rates to current SoC first-line chemotherapy, most patients with locally advanced or metastatic urothelial Carcinoma (UC) eventually experience disease progression. With no defined SoC second-line therapies, prognosis remains poor. Durvalumab is a selective, high affinity, engineered human IgG1 mAb that blocks programmed cell death ligand-1 binding to programmed cell death-1 and CD80. Most current Phase 3 trials of durvalumab were initiated using weight-based dosing (mg/kg) regimens. STRONG (NCT03084471), a Phase 3b safety study of durvalumab alone or in combination with the anti-CTLA-4 agent tremelimumab is being conducted to expand understanding of the safety of fixed dosing in patients with advanced solid tumors. Module A of the study is enrolling patients with UC and non-urothelial Carcinoma of the Urinary Tract (any histology) for treatment with durvalumab in the second-line setting post-chemotherapy. Other study modules will include durvalumab + tremel...
Hugh A Mostafid - One of the best experts on this subject based on the ideXlab platform.
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european association of urology guidelines on upper Urinary Tract urothelial cell Carcinoma 2015 update
European Urology, 2015Co-Authors: Morgan Rouprêt, Richard Zigeuner, Richard Sylvester, Marko Babjuk, Eva Comperat, Maximilian Burger, Nigel C Cowan, Paolo Gontero, Bas W G Van Rhijn, Hugh A MostafidAbstract:AbsTract Context The European Association of Urology (EAU) guidelines panel on upper Urinary Tract urothelial cell Carcinoma (UTUC) has prepared updated guidelines to aid clinicians in the current evidence-based management of UTUC and to incorporate recommendations into clinical practice. Objective To provide a brief overview of the EAU guidelines on UTUC as an aid to clinicians. Evidence acquisition The recommendations provided in the current guidelines are based on a thorough review of available UTUC guidelines and articles identified following a systematic search of Medline. Data on urothelial malignancies and UTUC were searched using these keywords: Urinary Tract cancer; urothelial Carcinomas; upper Urinary Tract, Carcinoma; renal pelvis; ureter; bladder cancer; chemotherapy; nephroureterectomy; adjuvant treatment; instillation; neoadjuvant treatment; recurrence; risk factors; and survival. References were weighted by a panel of experts. Evidence synthesis Due to the rarity of UTUC, there are insufficient data to provide strong recommendations (ie, grade A). However, the results of recent multicentre studies are now available, and there is a growing interest in UTUC. The 2009 TNM classification is recommended. Recommendations are given for diagnosis and risk stratification as well as radical and conservative treatment, and prognostic factors are discussed. A single postoperative dose of intravesical mitomycin after nephroureterectomy reduces the risk of bladder tumour recurrence. Recommendations are also provided for patient follow-up after different therapeutic strategies. Conclusions These guidelines contain information on the management of individual patients according to a current standardised approach. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen, based on the proposed risk stratification of these tumours. Patient summary Urothelial Carcinoma of the upper Urinary Tract is rare, but because 60% of these tumours are invasive at diagnosis, an appropriate diagnosis is most important. A number of known risk factors exist.
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european association of urology guidelines on upper Urinary Tract urothelial cell Carcinoma 2015 update
European Urology, 2015Co-Authors: Morgan Rouprêt, Richard Zigeuner, Richard Sylvester, Marko Babjuk, Eva Comperat, Maximilian Burger, Nigel C Cowan, Paolo Gontero, Bas W G Van Rhijn, Hugh A MostafidAbstract:AbsTract Context The European Association of Urology (EAU) Guidelines Panel on Upper Urinary Tract Urothelial Carcinoma (UTUC) has prepared updated guidelines to aid clinicians in the current evidence-based management of UTUC and to incorporate recommendations into clinical practice. Objective To provide an overview of the EAU guidelines on UTUC as an aid to clinicians. Evidence acquisition The recommendations provided in the current guidelines are based on a thorough review of available UTUC guidelines and articles identified following a systematic search of Medline. Data on urothelial malignancies and UTUC were searched using the following keywords: Urinary Tract cancer; urothelial Carcinomas; upper Urinary Tract, Carcinoma; renal pelvis; ureter; bladder cancer; chemotherapy; ureteroscopy; nephroureterectomy; adjuvant treatment; instillation; recurrence; risk factors; and survival. References were weighted by a panel of experts. Evidence synthesis Owing to the rarity of UTUC, there are insufficient data to provide strong recommendations (ie, grade A). However, the results of recent multicentre studies are now available, and there is a growing number of retrospective articles in UTUC. The 2017 tumour, node, metastasis (TNM) classification is recommended. Recommendations are given for diagnosis and risk stratification, as well as for radical and conservative treatment; prognostic factors are also discussed. A single postoperative dose of intravesical mitomycin after radical nephroureterectomy reduces the risk of bladder tumour recurrence. Kidney-sparing management should be offered as a primary treatment option to patients with low-risk tumours and two functional kidneys. Conclusions These guidelines contain information on the management of individual patients according to a current standardised approach. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen, based on the proposed risk stratification of these tumours. Patient summary Urothelial Carcinoma of the upper Urinary Tract is rare, but because 60% of these tumours are invasive at diagnosis; appropriate diagnosis and management is most important. We present recommendations based on current evidence for optimal management.
Cora N Sternberg - One of the best experts on this subject based on the ideXlab platform.
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an open label multicenter phase iiib study of patients with Urinary Tract Carcinoma utc strong final analysis for fixed dose durvalumab monotherapy module a
Journal of Clinical Oncology, 2021Co-Authors: Guru Sonpavde, Yohann Loriot, Cora N Sternberg, Aurelien Marabelle, Jaelyun Lee, Aude Flechon, Guilhem Roubaud, Damien Pouessel, Vittorina Zagonel, Fabio CalabroAbstract:429Background: Patients (pts) with advanced UTC who fail first-line therapy have poor prognoses. Durvalumab (D; anti-PD-L1) 10 mg/kg every 2 weeks is approved for treatment of metastatic urothelial...
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safety and efficacy of atezolizumab in patients with autoimmune disease subgroup analysis of the saul study in locally advanced metastatic Urinary Tract Carcinoma
European Journal of Cancer, 2020Co-Authors: Yohann Loriot, Daniel Castellano, Cora N Sternberg, Sjoukje F Oosting, Herlinde Dumez, Robert Huddart, Karina Vianna, Teresa Alonso Gordoa, Iwona Skoneczna, Andre P FayAbstract:AbsTract Aim Patients with pre-existing autoimmune disease (AID) are typically excluded from clinical trials of immune checkpoint inhibitors, and there are limited data on outcomes in this population. The single-arm international SAUL study of atezolizumab enrolled a broader ‘real-world’ patient population. We present outcomes in patients with a history of AID. Methods Patients with locally advanced/metastatic Urinary Tract Carcinoma received atezolizumab 1200 mg every 3 weeks until loss of clinical benefit or unacceptable toxicity. The primary end-point was safety. Overall survival (OS) was a secondary end-point. Subgroup analyses of AID patients were prespecified. Results Thirty-five of 997 treated patients had AID at baseline, most commonly psoriasis (n = 15). Compared with non-AID patients, AID patients experienced numerically more adverse events (AEs) of special interest (46% versus 30%; grade ≥III 14% versus 6%) and treatment-related grade III/IV AEs (26% versus 12%), but without relevant increases in treatment-related deaths (0% versus 1%) or AEs necessitating treatment discontinuation (9% versus 6%). Pre-existing AID worsened in four patients (11%; two flares in two patients); three of the six flares resolved, one was resolving, and two were unresolved. Efficacy was similar in AID and non-AID patients (median OS, 8.2 versus 8.8 months, respectively; median progression-free survival, 4.4 versus 2.2 months; disease control rate, 51% versus 39%). Conclusions In 35 atezolizumab-treated patients with pre-existing AID, incidences of special interest and treatment-related AEs appeared acceptable. AEs were manageable, rarely requiring atezolizumab discontinuation. Treating these patients requires caution, but pre-existing AID does not preclude atezolizumab therapy. Trial registration NCT02928406.
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an open label multicenter phase iiib study of patients with Urinary Tract Carcinoma utc strong interim safety results for fixed dose durvalumab d monotherapy module a
Journal of Clinical Oncology, 2020Co-Authors: Guru Sonpavde, Paulo Miranda, Cora N Sternberg, Jaelyun Lee, Ana Rita Lima, Makan Sarkeshik, Sebastien J HotteAbstract:484Background: Patients (pts) with advanced UTC who fail first-line therapy have a poor prognosis and limited treatment options, with only modest benefit from chemotherapy. D (anti-PD-L1 antibody) ...
Marianne Brehmer - One of the best experts on this subject based on the ideXlab platform.
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Consultation on UTUC, Stockholm 2018 aspects of diagnosis of upper Tract urothelial Carcinoma
World Journal of Urology, 2019Co-Authors: Grzegorz Fojecki, Olivier Traxer, Palle Jörn Sloth Osther, Anders Magnusson, Joyce Baard, Georg Jaremko, Christian Seitz, Thomas Knoll, Guido Giusti, Marianne BrehmerAbstract:Purpose To summarize knowledge on upper Urinary Tract Carcinoma (UTUC) regarding diagnostic procedures, risk factors and prognostic markers. Methods A scoping review approach was applied to search literature in Pubmed, Web of Science, and Embase. Consensus was reached through discussions at Consultation on UTUC in Stockholm, September 2018. Results Tumor stage and grade are the most important prognostic factors. CT urography (CTU) including corticomedullary phase is the preferred imaging modality. A clear tumor on CTU in combination with high-grade UTUC in urine cytology identifies high-risk UTUC, and in some cases indirect staging can be obtained. Bladder urine cytology has limited sensitivity, and in most cases ureterorenoscopy (URS) with in situ samples for cytology and histopathology are mandatory for exact diagnosis. Image-enhancing techniques, Image S1 and narrow-band imaging, may improve tumor detection at URS. Direct confocal laser endomicroscopy may help to define grade during URS. There is strong correlation between stage and grade, accordingly correct grading is crucial. The correlation is more pronounced using the 1999 WHO than the 2004 classification: however, the 1999 system risks greater interobserver variability. Using both systems is advisable. A number of tissue-based molecular markers have been studied. None has proven ready for use in clinical practice. Conclusions Correct grading and staging of UTUC are mandatory for adequate treatment decisions. Optimal diagnostic workup should include CTU with corticomedullary phase, URS with in situ cytology and biopsies. Both WHO classification systems (1999 and 2004) should be used to decrease risk of undergrading or overtreatment.
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Consultation on UTUC, Stockholm 2018 aspects of risk stratification: long-term results and follow-up
World Journal of Urology, 2019Co-Authors: Mudhar Hasan, Morgan Rouprêt, Francis Keeley, Cecilia Cracco, Robert Jones, Michael Straub, Olivier Traxer, Palle Jörn Sloth Osther, Marianne BrehmerAbstract:PURPOSE : To summarize current knowledge on upper Urinary Tract Carcinoma (UTUC) regarding risk stratification, long-term results, and follow-up. METHODS : A scoping review approach was applied to search literature in Pubmed, Web of Science, and Embase. Consensus was reached through discussions at Consultation on UTUC, September 2018, Stockholm. RESULTS : To optimize oncological outcome considering both cancer-specific survival (CSS) and overall survival (OS), it is essential to identify pre- and postoperative prognostic factors. In low-risk UTUC, kidney-sparing surgery (KSS) and radical nephroureterectomy (RNU) offer equivalent CSS, whereas RNU may result in poorer OS due to nephron loss. For more aggressive tumours, undergrading can lead to insufficient treatment. The strongest prognostic factors are tumour stage and grade. Determining grade is best achieved by ureterorenoscopy (URS) with focal samples, biopsy and cytology. Staging is more difficult but can be indirectly achieved by multiphase computed tomography urography (CTU) or tumour grade determined by cytology and histopathology. Patients treated with KSS should be monitored closely with regular follow-ups (URS and CTU). CONCLUSION : KSS should be offered in low-risk UTUC when feasible, whereas RNU is the treatment of choice in organ-confined high-risk UTUC. Intravesical recurrence (IVR) is common after RNU, but a single postoperative dose of mitomycin instillation decreases IVR. Endourological management has high local and bladder recurrence rates; however, its effect on CSS or overall survival OS is unclear. RNU is associated with significant risk of chronic kidney disease. Careful selection of patients and risk stratification are mandatory, and patients should be followed according to strict protocols.
