Endoluminal Gemcitabine-Docetaxel as a Renal-Sparing Option for Select Patients With High Grade Upper-Tract Urothelial Carcinoma

According to a retrospective study, gemcitabine plus docetaxel demonstrated promising safety and efficacy among appropriately selected patients with high-grade upper-tract urothelial carcinoma.

While radical nephrouretectomy is the preferred management of high-grade upper-tract urothelial carcinoma, many patients are not surgical candidates, or refuse radical surgery. Endoscopic resection/ablation and topical therapy, typically with bacillus Calmette-Guerin (BCG), has emerged as a potential option, however cohorts in this treatment are small and BCG shortages deter widespread adoption.

Ian M McElree, MS, Carver College of Medicine at University of Iowa, Iowa City, Iowa, and coauthors wrote that gemcitabine/docetaxel “has shown favorable efficacy in non–muscle-invasive bladder cancer.” Given that success, gemcitabine/docetaxel “was later utilized as first-line treatment for select patients with [high-grade upper-tract urothelial carcinoma],” they explained.

This retrospective review included 31 patients with 41 upper tract units with clinically non-invasive high-grade upper-tract urothelial carcinoma with no radiographic or endoscopically visible disease, either at diagnosis or following ablation. Treatment was instilled via nephrostomy or retrograde ureteral catheter, with induction instillations weekly for 6 weeks followed by 6 monthly instillations for those patients who were disease-free.

The median follow-up was 29 months. Recurrence-free survival was 75% at 1 year, 54% at 2 years, and 40% at 3 years. The 3-year progression-free survival and overall survival were both 75%. Adverse events of any grade occurred in 52% of patients (n = 16), with 5 grade 3 and 1 grade 5. There were 5 patients who died from urothelial carcinoma.

McElree et al concluded, “treatment with sequential endoluminal [gemcitabine/docetaxel] resulted in reasonable efficacy and tolerance.” They added, “Careful patient selection is necessary given the possibility of understaging and disease progression during treatment.”

Source:

McElree IM, Belzer A, Mott SL, et al. Sequential endoluminal gemcitabine and docetaxel for the treatment of clinically non-invasive high-grade upper tract urothelial carcinoma. Urol Oncol. 2024;42(1):20.e19-20.e15. doi: 10.1016/j.urolonc.2023.03.013