Pham M N, Apolo A B, De Santis M, Galsky M D, Leibovich B C, Pisters L L, Siefker-Radtke A O, Sonpavde G, Steinberg G D, Sternberg C N, Tagawa S T, Weizer A Z, Woods M E, Milowsky M I
University of North Carolina School of Medicine, Chapel Hill, NC, USA.
National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
World J Urol. 2017 Mar;35(3):367-378. doi: 10.1007/s00345-016-1885-4. Epub 2016 Jun 24.
To review the management of metastatic upper tract urothelial carcinoma (UTUC) including recent advances in targeted and immune therapies as an update to the 2014 joint international consultation on UTUC, co-sponsored by the Société Internationale d'Urologie and International Consultation on Urological Diseases.
A PubMed database search was performed between January 2013 and May 2016 related to the treatment of metastatic UTUC, and 54 studies were selected for inclusion.
The management of patients with metastatic UTUC is primarily an extrapolation from evidence guiding the management of metastatic urothelial carcinoma of the bladder. The first-line therapy for metastatic UTUC is platinum-based combination chemotherapy. Standard second-line therapies are limited and ineffective. Patients with UTUC who progress following platinum-based chemotherapy are encouraged to participate in clinical trials. Recent advances in genomic profiling present exciting opportunities to guide the use of targeted therapy. Immunotherapy with checkpoint inhibitors has demonstrated extremely promising results. Retrospective studies provide support for post-chemotherapy surgery in appropriately selected patients.
The management of metastatic UTUC requires a multi-disciplinary approach. New insights from genomic profiling using targeted therapies, novel immunotherapies, and surgery represent promising avenues for further therapeutic exploration.
回顾转移性上尿路尿路上皮癌（UTUC）的治疗，包括靶向治疗和免疫治疗的最新进展，作为2014年由国际泌尿外科学会和国际泌尿疾病咨询会共同发起的UTUC联合国际咨询会的更新内容。
在2013年1月至2016年5月期间对PubMed数据库进行检索，查找与转移性UTUC治疗相关的研究，共筛选出54项研究纳入分析。
转移性UTUC患者的治疗主要是基于指导膀胱转移性尿路上皮癌治疗的证据进行推断。转移性UTUC的一线治疗是铂类联合化疗。标准的二线治疗方法有限且效果不佳。铂类化疗后病情进展的UTUC患者鼓励参加临床试验。基因组分析的最新进展为指导靶向治疗的应用提供了令人兴奋的机会。使用检查点抑制剂的免疫治疗已显示出极有前景的结果。回顾性研究为在适当选择的患者中进行化疗后手术提供了支持。
转移性UTUC的治疗需要多学科方法。利用靶向治疗、新型免疫治疗和手术进行基因组分析所获得的新见解，是进一步治疗探索的有前景途径。
