Volume 23, Number 4Coding CornerReimbursement Considerations for Instillation of Medications to Treat Low-Grade Upper Tract Urothelial CarcinomaJonathan RubensteinMark PainterCeleste KirschnerUnlike non–muscle invasive bladder cancer, which can be treated with surgical and intravesical medication administration, upper tract urothelial (renal pelvis and ureter) cancer was historically treated only surgically. If a tumor could not be treated with ureteroscopic or percutaneous surgical control, removal of the kidney and ureter was often the only treatment option. When mitomycin for pyelocalyceal instillation 0.4% gel for low-grade upper urothelial cancer became commercially available, nonsurgical treatment became possible.MitomycinAdministration intravesicalureteral neoplasms
Volume 23, Number 2Bladder CancerIntegrating JELMYTO (Mitomycin) for Pyelocalyceal Solution Into Community Practice: Practical Tips for the UrologistMichael J. ShannonSandip M. PrasadTreatment options for upper-tract urothelial carcinoma are based on whether the patient has high-risk or low-risk disease. Low-grade tumors can be managed with nephron-sparing approaches, including ureteroscopic resection and ablation, although most patients undergoing endoscopic treatment of upper-tract urothelial cancers face a risk of recurrence. Mitomycin gel for pyelocalyceal solution provides an effective alternative therapy. In OLYMPUS, a phase 3, single-arm, open-label study, 58% of patients with low-grade disease experienced a complete response to induction therapy at 3 months. Kaplan-Meier analysis revealed an estimated 12-month durable response rate of 82%. The most common treatment-emergent adverse events were ureteric stenosis, urinary tract infection, hematuria, and flank pain (grade <3). Mitomycin gel offers a novel, kidney-sparing, nonoperative approach to managing low-grade upper-tract urothelial carcinoma.MitomycinUrologyDrug therapyUrinary tractCarcinomaUrologic neoplasmsurinary bladder neoplasms
Volume 22, Number 2Review ArticlesNon–muscle-invasive Bladder Cancer: Overview and Contemporary Treatment Landscape of Neoadjuvant Chemoablative TherapiesTreatment UpdateRichard S MatulewiczGary D SteinbergNon–muscle-invasive bladder cancer (NMIBC) is a heterogeneous subclassification of urothelial carcinoma with significant variation in individual risk of recurrence and progression to muscle-invasive disease. Risk stratification by American Urological Association (AUA) and European Association of Urology (EAU) guidelines or by using nomograms/risk calculators developed from clinical trial data can help inform patient treatment decisions but may not accurately classify all patients. Risk-adapted adjuvant (post–transurethral resection of bladder tumor [TURBT]) treatment strategies using intravesical therapies are an important means of balancing disease control with potential adverse effects. Adjuvant intravesical instillation with various chemotherapy agents and bacillus Calmette-Guérin (BCG) is well studied and associated with excellent outcomes for most patients. However, upwards of 40% of patients recur within 2 years and roughly 10% progress to muscle-invasive bladder cancer. Novel approaches and agents that aim to reduce the treatment burden associated with NMIBC are increasingly needed. We review the current landscape of NMIBC as it pertains to the use of and rationale for emerging neoadjuvant chemoablative therapies. [Rev Urol. 2020;22(2):43–51] © 2020 MedReviews®, LLCUrothelial carcinomaBacillus Calmette-GuérinNon-muscle invasive bladder cancerMitomycin