An estimated 9,000 Americans each year are diagnosed with upper tract urothelial cancer (UTUC), which affects the renal pelvis or ureter and is difficult to treat.
Greenberg Bladder Cancer Institute clinicians and scientists are pioneering innovative treatments to manage this rare, complex disease.
Topical Therapy for Low-Grade UTUC: Hydrogel Helps Save the Kidney
One of the challenges of treating low-grade UTUC is its location: the ureter, the tube that conveys urine from each kidney to the bladder, is very narrow; about 4 mm or less in diameter.
“The small size of the ureter has prevented adequate treatment with current technologies – until now,” says urologist Phillip Pierorazio, M.D. A novel hydrogel may be the game-changer doctors and patients have been waiting for. “This hydrogel is liquid when cooled, but it solidifies as it warms to body temperature. It can be infused with chemotherapy and delivered into the kidney to treat UTUC topically.”
The chemotherapy used in this case is Mitomycin C, a proven performer in bladder cancer, Pierorazio adds. “It’s very effective at killing urothelial cancers, and works great in the bladder.” The hydrogel is essential in getting – and keeping – the drug in place. “Before this drug became available, we had no means to get chemotherapy to stay in the kidney. Normal urine flow would wash it out before the drug could kill the cancer.”
The hydrogel, called Jelmyto, takes six hours to dissolve and release chemotherapy after it solidifies in the kidney. Pierorazio and colleagues at Hopkins were investigators in the first clinical trial using Mitomycin C for patients with low-grade UTUC. The trial’s results, published in Lancet Oncology, found no evidence of cancer one year after treatment in 60 percent of patients.
While up to 40 percent of patients experienced an inflammatory narrowing of the ureter, for nearly all of them, these symptoms were transient, and almost all patients were able to preserve their kidney. “This is a major paradigm shift for patients with low-grade UTUC,” says Nirmish Singla, M.D., M.SC., Director of Translational Research in Genitourinary Oncology and Co-Director of the UTUC multidisciplinary clinic. “Previously, all we had to offer were ineffective technologies or radical surgery. Now we have a topical therapy, and we expect more therapies to emerge in the coming years.” Hopkins is also a site for the ENLIGHTENED study, which will investigate a laser-based photodynamic therapy to ablate UTUC in the renal pelvis.