The ablative effect of mitomycin reverse thermal gel: Expanding the role for nephron preservation therapy in low grade upper tract urothelial carcinoma.
california; santa monica; Biopsy only; Chemo-ablation; Mechanical ablation; Mitomycin; Upper tract urothelial carcinoma, Reverse thermal polymer gel
PURPOSE: Assess the real-world ablative effect of mitomycin reverse thermal gel for low-grade upper tract urothelial carcinoma (UTUC) in patients who undergo biopsy only or partial ablation and evaluate utility of complete ablation prior to UGN-101.
MATERIAL AND METHODS: We retrospectively reviewed low-grade UTUC patients treated with UGN-101 from 15 high-volume centers. Patients were categorized based on initial endoscopic ablation (biopsy only, partial ablation, or complete ablation) and by size of remaining tumor (complete ablation,3cm) prior to UGN-101. The primary outcome was rendered disease free (RDF) rate at first post-UGN-101 ureteroscopy (URS), defined as complete response or partial response with minimal mechanical ablation to endoscopically clear the upper tract of visible disease.
RESULTS: One hundred and sixteen patients were included for analysis after excluding those with high-grade disease. At first post-UGN-101 URS, there were no differences in RDF rates between those who at initial URS (pre-UGN-101) had complete ablation (RDF 77.0%), partial ablation (RDF 55.9%) or biopsy only (RDF 66.7%) (P = 0.14). Similarly, a complimentary analysis focusing on tumor size (completely ablated,3cm) prior to UGN-101 induction did not demonstrate significant differences in RDF rates (P = 0.17).
CONCLUSION: The results of the early real-world experience suggest that UGN-101 may play a role in initial chemo-ablative cytoreduction of larger volume low-grade tumors that may not initially appear to be amenable to renal preservation. Further studies will help to better quantify the chemo-ablative effect and to identify clinical factors for patient selection.
Kaimakliotis, Hristos Z; Tachibana, Isamu; Woldu, Solomon; Labbate, Craig; Jacob, Joseph; Murray, Katie; Rose, Kyle; Sexton, Wade; Dickstein, Rian; Linehan, Jennifer M; Nieder, Alan; Bjurlin, Marc; Humphreys, Mitchell; Ghodoussipor, Saum; Quek, Marcus; O'Donnell, Michael; Eisner, Brian H; Matin, Surena F; Lotan, Yair; and Feldman, Adam S, "The ablative effect of mitomycin reverse thermal gel: Expanding the role for nephron preservation therapy in low grade upper tract urothelial carcinoma." (2023). Articles, Abstracts, and Reports. 7494.