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Upper tract urothelial carcinoma topical issue 2016: treatment of metastatic cancer

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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References

  1. Committee 6, Milowsky MI, De Santis M, Apolo AB, Galsky MD, Leibovich BC, Siefker-Radke AO, Sonpavde G, Steinberg GD, Sternberg CN, Tagawa ST, Weizer AZ, Woods ME (2014) Treatment of Metastatic Cancer. In: Shariat SF, Matin S, Stenzl A (eds) Upper Tract Urothelial Carcinoma. Société Internationale d’Urologie, Montréal, pp 263–283

  2. Galsky MD, Hahn NM, Rosenberg J et al (2011) A consensus definition of patients with metastatic urothelial carcinoma who are unfit for cisplatin-based chemotherapy. Lancet Oncol 12:211–214. doi:10.1016/S1470-2045(10)70275-8

    Article  PubMed  Google Scholar 

  3. Sternberg CN, Yagoda A, Scher HI et al (1989) Methotrexate, vinblastine, doxorubicin, and cisplatin for advanced transitional cell carcinoma of the urothelium. Efficacy and patterns of response and relapse. Cancer 64:2448–2458

    Article  CAS  PubMed  Google Scholar 

  4. Loehrer PJ, Einhorn LH, Elson PJ et al (1992) A randomized comparison of cisplatin alone or in combination with methotrexate, vinblastine, and doxorubicin in patients with metastatic urothelial carcinoma: a cooperative group study. J Clin Oncol 10:1066–1073

    Article  PubMed  Google Scholar 

  5. Sternberg CN, de Mulder PHM, Schornagel JH et al (2001) Randomized phase III trial of high–dose-intensity methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) chemotherapy and recombinant human granulocyte colony-stimulating factor versus classic MVAC in advanced urothelial tract tumors: European Organization for Research and Treatment of Cancer Protocol No. 30924. J Clin Oncol 19:2638–2646

    Article  CAS  PubMed  Google Scholar 

  6. Sternberg CN, de Mulder P, Schornagel JH et al (2006) Seven year update of an EORTC phase III trial of high-dose intensity M-VAC chemotherapy and G-CSF versus classic M-VAC in advanced urothelial tract tumours. Eur J Cancer 42:50–54. doi:10.1016/j.ejca.2005.08.032

    Article  CAS  PubMed  Google Scholar 

  7. von der Maase H, Hansen SW, Roberts JT et al (2000) Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol 18:3068–3077

    Article  PubMed  Google Scholar 

  8. Dreicer R, Manola J, Roth BJ et al (2004) Phase III trial of methotrexate, vinblastine, doxorubicin, and cisplatin versus carboplatin and paclitaxel in patients with advanced carcinoma of the urothelium. Cancer 100:1639–1645. doi:10.1002/cncr.20123

    Article  CAS  PubMed  Google Scholar 

  9. Bamias A, Aravantinos G, Deliveliotis C et al (2004) Docetaxel and cisplatin with granulocyte colony-stimulating factor (G-CSF) versus MVAC with G-CSF in advanced urothelial carcinoma: a multicenter, randomized, phase III study from the Hellenic Cooperative Oncology Group. J Clin Oncol 22:220–228. doi:10.1200/JCO.2004.02.152

    Article  CAS  PubMed  Google Scholar 

  10. Bamias A, Dafni U, Karadimou A et al (2013) Prospective, open-label, randomized, phase III study of two dose-dense regimens MVAC versus gemcitabine/cisplatin in patients with inoperable, metastatic or relapsed urothelial cancer: a Hellenic Cooperative Oncology Group study (HE 16/03). Ann Oncol 24:1011–1017. doi:10.1093/annonc/mds583

    Article  CAS  PubMed  Google Scholar 

  11. Bellmunt J, von der Maase H, Mead GM et al (2012) Randomized phase III study comparing paclitaxel/cisplatin/gemcitabine and gemcitabine/cisplatin in patients with locally advanced or metastatic urothelial cancer without prior systemic therapy: EORTC Intergroup Study 30987. J Clin Oncol 30:1107–1113. doi:10.1200/JCO.2011.38.6979

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Geldart T, Chester J, Casbard A et al (2015) SUCCINCT: an open-label, single-arm, non-randomised, phase 2 trial of gemcitabine and cisplatin chemotherapy in combination with sunitinib as first-line treatment for patients with advanced urothelial carcinoma. Eur Urol 67:599–602. doi:10.1016/j.eururo.2014.11.003

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Krege S, Rexer H, vom Dorp F et al (2014) Prospective randomized double-blind multicentre phase II study comparing gemcitabine and cisplatin plus sorafenib chemotherapy with gemcitabine and cisplatin plus placebo in locally advanced and/or metastasized urothelial cancer: SUSE (AUO-AB 31/05). BJU Int 113:429–436. doi:10.1111/bju.12437

    Article  CAS  PubMed  Google Scholar 

  14. Kaag MG, O’Malley RL, O’Malley P et al (2010) Changes in renal function following nephroureterectomy may affect the use of perioperative chemotherapy. Eur Urol 58:581–587. doi:10.1016/j.eururo.2010.06.029

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kaag M, Trost L, Thompson RH et al (2014) Preoperative predictors of renal function decline after radical nephroureterectomy for upper tract urothelial carcinoma. BJU Int 114:674–679. doi:10.1111/bju.12597

    Article  CAS  PubMed  Google Scholar 

  16. De Santis M, Bellmunt J, Mead G et al (2012) Randomized phase II/III trial assessing gemcitabine/carboplatin and methotrexate/carboplatin/vinblastine in patients with advanced urothelial cancer who are unfit for cisplatin-based chemotherapy: EORTC Study 30986. J Clin Oncol 30:191–199. doi:10.1200/JCO.2011.37.3571

    Article  PubMed  Google Scholar 

  17. Balar AV, Apolo AB, Ostrovnaya I et al (2013) Phase II study of gemcitabine, carboplatin, and bevacizumab in patients with advanced unresectable or metastatic urothelial cancer. J Clin Oncol 31:724–730. doi:10.1200/JCO.2012.42.5215

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Hussain SA, Stocken DD, Riley P et al (2004) A phase I/II study of gemcitabine and fractionated cisplatin in an outpatient setting using a 21-day schedule in patients with advanced and metastatic bladder cancer. Br J Cancer 91:844–849. doi:10.1038/sj.bjc.6602112

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Morales-Barrera R, Bellmunt J, Suárez C et al (2012) Cisplatin and gemcitabine administered every two weeks in patients with locally advanced or metastatic urothelial carcinoma and impaired renal function. Eur J Cancer 48:1816–1821. doi:10.1016/j.ejca.2012.04.002

    Article  CAS  PubMed  Google Scholar 

  20. De Santis M, Wiechno PJ, Bellmunt J et al (2016) Vinflunine–gemcitabine versus vinflunine–carboplatin as first-line chemotherapy in cisplatin-unfit patients with advanced urothelial carcinoma: results of an international randomized phase II trial (JASINT1). Ann Oncol 27:449–454. doi:10.1093/annonc/mdv609

    Article  PubMed  Google Scholar 

  21. Bellmunt J, Théodore C, Demkov T et al (2009) Phase III trial of vinflunine plus best supportive care compared with best supportive care alone after a platinum-containing regimen in patients with advanced transitional cell carcinoma of the urothelial tract. J Clin Oncol 27:4454–4461. doi:10.1200/JCO.2008.20.5534

    Article  CAS  PubMed  Google Scholar 

  22. Sweeney CJ, Roth BJ, Kabbinavar FF et al (2006) Phase II study of pemetrexed for second-line treatment of transitional cell cancer of the urothelium. J Clin Oncol 24:3451–3457. doi:10.1200/JCO.2005.03.6699

    Article  CAS  PubMed  Google Scholar 

  23. Vaughn DJ, Broome CM, Hussain M et al (2002) Phase II trial of weekly paclitaxel in patients with previously treated advanced urothelial cancer. J Clin Oncol 20:937–940

    Article  CAS  PubMed  Google Scholar 

  24. McCaffrey JA, Hilton S, Mazumdar M et al (1997) Phase II trial of docetaxel in patients with advanced or metastatic transitional-cell carcinoma. J Clin Oncol 15:1853–1857

    Article  CAS  PubMed  Google Scholar 

  25. Petrylak DP, Tagawa ST, Kohli M et al (2016) Docetaxel as monotherapy or combined with ramucirumab or icrucumab in second-line treatment for locally advanced or metastatic urothelial carcinoma: an open-label, three-arm, randomized controlled phase II trial. J Clin Oncol 34:1500–1509. doi:10.1200/JCO.2015.65.0218

    Article  CAS  PubMed  Google Scholar 

  26. Cancer Genome Atlas Research Network (2014) Comprehensive molecular characterization of urothelial bladder carcinoma. Nature 507:315–322. doi:10.1038/nature12965

    Article  Google Scholar 

  27. Balar AV, Milowsky MI (2015) Cytotoxic and DNA-targeted therapy in urothelial cancer: have we squeezed the lemon enough? Cancer 121:179–187. doi:10.1002/cncr.28754

    Article  PubMed  Google Scholar 

  28. Palma N, Morris JC, Ali SM et al (2015) Exceptional response to pazopanib in a patient with urothelial carcinoma harboring FGFR3 activating mutation and amplification. Eur Urol 68:168–170. doi:10.1016/j.eururo.2015.02.023

    Article  PubMed  Google Scholar 

  29. Pili R, Qin R, Flynn PJ et al (2013) A phase II safety and efficacy study of the vascular endothelial growth factor receptor tyrosine kinase inhibitor pazopanib in patients with metastatic urothelial cancer. Clin Genitourin Cancer 11:477–483. doi:10.1016/j.clgc.2013.05.005

    Article  PubMed  PubMed Central  Google Scholar 

  30. Wagle N, Grabiner BC, Allen EMV et al (2014) Activating mTOR mutations in a patient with an extraordinary response on a phase I trial of everolimus and pazopanib. Cancer Discov 4:546–553. doi:10.1158/2159-8290.CD-13-0353

    Article  PubMed  PubMed Central  Google Scholar 

  31. Choi W, Porten S, Kim S et al (2014) Identification of distinct basal and luminal subtypes of muscle-invasive bladder cancer with different sensitivities to frontline chemotherapy. Cancer Cell 25:152–165. doi:10.1016/j.ccr.2014.01.009

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Damrauer JS, Hoadley KA, Chism DD et al (2014) Intrinsic subtypes of high-grade bladder cancer reflect the hallmarks of breast cancer biology. Proc Natl Acad Sci USA 111:3110–3115. doi:10.1073/pnas.1318376111

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. McConkey DJ, Choi W, Shen Y et al (2015) A prognostic gene expression signature in the molecular classification of chemotherapy-naïve urothelial cancer is predictive of clinical outcomes from neoadjuvant chemotherapy: a phase 2 trial of dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin with bevacizumab in urothelial cancer. Eur Urol. doi:10.1016/j.eururo.2015.08.034

    PubMed Central  Google Scholar 

  34. Rosenberg JE, Hoffman-Censits J, Powles T et al (2016) Atezolizumab in patients with locally advanced and metastatic urothelial carcinoma who have progressed following treatment with platinum-based chemotherapy: a single-arm, multicentre, phase 2 trial. Lancet. doi:10.1016/S0140-6736(16)00561-4

    PubMed Central  Google Scholar 

  35. Sfakianos JP, Cha EK, Iyer G et al (2015) Genomic characterization of upper tract urothelial carcinoma. Eur Urol 68:970–977. doi:10.1016/j.eururo.2015.07.039

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Bellmunt J, Werner L, Leow JJ et al (2015) Somatic copy number abnormalities and mutations in PI3 K/AKT/mTOR pathway have prognostic significance for overall survival in platinum treated locally advanced or metastatic urothelial tumors. PLOS ONE 10:e0124711. doi:10.1371/journal.pone.0124711

    Article  PubMed  PubMed Central  Google Scholar 

  37. Mullane SA, Bellmunt J (2016) Re: John P. Sfakianos, Eugene K. Cha, Gopa Iyer, et al. Genomic characterization of upper tract urothelial carcinoma. Eur Urol 2015 68:970–977. doi:10.1016/j.eururo.2016.01.036

    Google Scholar 

  38. Plimack ER, Bellmunt J, Gupta S et al (2015) Pembrolizumab (MK-3475) for advanced urothelial cancer: updated results and biomarker analysis from KEYNOTE-012. ASCO Meet Abstr 33:4502

    Google Scholar 

  39. Apolo AB, Infante JR, Hamid O et al (2016) Safety, clinical activity, and PD-L1 expression of avelumab (MSB0010718C), an anti-PD-L1 antibody, in patients with metastatic urothelial carcinoma from the JAVELIN Solid Tumor phase Ib trial. ASCO Meet Abstr 34:367

    Google Scholar 

  40. Agarwal N, Bellmunt J, Maughan BL et al (2014) Six-month progression-free survival as the primary endpoint to evaluate the activity of new agents as second-line therapy for advanced urothelial carcinoma. Clin Genitourin Cancer 12:130–137. doi:10.1016/j.clgc.2013.09.002

    Article  PubMed  Google Scholar 

  41. Dimopoulos MA, Finn L, Logothetis CJ (1994) Pattern of failure and survival of patients with metastatic urothelial tumors relapsing after cis-platinum-based chemotherapy. J Urol 151:598–600 (discussion 600–601)

    CAS  PubMed  Google Scholar 

  42. Youssef RF, Shariat SF, Lotan Y et al (2011) Upper urinary tract urothelial carcinoma with loco-regional nodal metastases: insights from the Upper Tract Urothelial Carcinoma Collaboration. BJU Int 108:1286–1291. doi:10.1111/j.1464-410X.2011.10075.x

    Article  PubMed  Google Scholar 

  43. Necchi A, Giannatempo P, Lo Vullo S et al (2015) Postchemotherapy lymphadenectomy in patients with metastatic urothelial carcinoma: long-term efficacy and implications for trial design. Clin Genitourin Cancer 13(80–86):e1. doi:10.1016/j.clgc.2014.06.003

    Google Scholar 

  44. Abe T, Kitamura H, Obara W et al (2014) Outcome of metastasectomy for urothelial carcinoma: a multi-institutional retrospective study in Japan. J Urol 191:932–936. doi:10.1016/j.juro.2013.11.004

    Article  PubMed  Google Scholar 

  45. Abe T, Shinohara N, Harabayashi T et al (2007) Impact of multimodal treatment on survival in patients with metastatic urothelial cancer. Eur Urol 52:1106–1113. doi:10.1016/j.eururo.2007.02.052

    Article  PubMed  Google Scholar 

  46. Ho PL, Willis DL, Patil J et al (2016) Outcome of patients with clinically node-positive bladder cancer undergoing consolidative surgery after preoperative chemotherapy: the M.D. Anderson Cancer Center Experience. Urol Oncol 34(59):e1–e8. doi:10.1016/j.urolonc.2015.08.012

    Google Scholar 

  47. Siefker-Radtke AO, Kamat AM, Williams DL et al (2009) A phase II randomized four-regimen selection trial incorporating response for sequential chemotherapy in metastatic, unresectable urothelial cancer: final results from the M. D. Anderson Cancer Center. ASCO Meet Abstr 27:5071

    Google Scholar 

  48. Nieuwenhuijzen JA, Bex A, Meinhardt W et al (2005) Neoadjuvant methotrexate, vinblastine, doxorubicin and cisplatin for histologically proven lymph node positive bladder cancer. J Urol 174:80–85. doi:10.1097/01.ju.0000162018.40891.ba

    Article  CAS  PubMed  Google Scholar 

  49. Sweeney P, Millikan R, Donat M et al (2003) Is there a therapeutic role for post-chemotherapy retroperitoneal lymph node dissection in metastatic transitional cell carcinoma of the bladder? J Urol 169:2113–2117. doi:10.1097/01.ju.0000067601.29966.4a

    Article  PubMed  Google Scholar 

  50. Cowles RS, Johnson DE, McMurtrey MJ (1982) Long-term results following thoracotomy for metastatic bladder cancer. Urology 20:390–392

    Article  CAS  PubMed  Google Scholar 

  51. Siefker-Radtke AO, Walsh GL, Pisters LL et al (2004) Is there a role for surgery in the management of metastatic urothelial cancer? The M. D. Anderson experience. J Urol 171:145–148. doi:10.1097/01.ju.0000099823.60465.e6

    Article  PubMed  Google Scholar 

  52. Kanzaki R, Higashiyama M, Fujiwara A et al (2010) Outcome of surgical resection of pulmonary metastasis from urinary tract transitional cell carcinoma. Interact CardioVasc Thorac Surg 11:60–64. doi:10.1510/icvts.2010.236687

    Article  PubMed  Google Scholar 

  53. Kim T, Ahn J-H, You D et al (2015) Pulmonary metastasectomy could prolong overall survival in select cases of metastatic urinary tract cancer. Clin Genitourin Cancer 13:e297–e304. doi:10.1016/j.clgc.2015.04.013

    Article  PubMed  Google Scholar 

  54. Matsuguma H, Yoshino I, Ito H et al (2011) Is there a role for pulmonary metastasectomy with a curative intent in patients with metastatic urinary transitional cell carcinoma? Ann Thorac Surg 92:449–453. doi:10.1016/j.athoracsur.2011.03.097

    Article  PubMed  Google Scholar 

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Author contributions

MN Pham: Data collection and management, data analysis, manuscript writing/editing; AB Apolo, M De Santis, MD Galsky, BC Leibovich, LL Pisters, AO Siefker-Radtke, G Sonpavde, GD Steinberg, CN Sternberg, ST Tagawa, AZ Weizer and ME Woods: Data analysis, manuscript writing/editing; MI Milowsky: Project development, data collection and management, data analysis, manuscript writing/editing.

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Author information

Authors and Affiliations

  1. University of North Carolina School of Medicine, Chapel Hill, NC, USA

    M. N. Pham

  2. National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    A. B. Apolo

  3. Cancer Research Unit, University of Warwick, Coventry, UK

    M. De Santis

  4. The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    M. D. Galsky

  5. Department of Urology, Mayo Clinic, Rochester, MN, USA

    B. C. Leibovich

  6. University of Texas MD Anderson Cancer Center, Houston, TX, USA

    L. L. Pisters & A. O. Siefker-Radtke

  7. University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL, USA

    G. Sonpavde

  8. Section of Urology, Department of Surgery, The University of Chicago Medical Center, Chicago, IL, USA

    G. D. Steinberg

  9. San Camillo and Forlanini Hospitals, Rome, Italy

    C. N. Sternberg

  10. Weill Cornell Medicine, New York, NY, USA

    S. T. Tagawa

  11. Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, MI, USA

    A. Z. Weizer

  12. Department of Urology, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA

    M. E. Woods

  13. Division of Hematology/Oncology, Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, 3rd Floor Physician’s Office Building, 170 Manning Drive, Chapel Hill, NC, 27599, USA

    M. I. Milowsky

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  1. M. N. Pham
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  2. A. B. Apolo
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  3. M. De Santis
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  4. M. D. Galsky
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  5. B. C. Leibovich
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  6. L. L. Pisters
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  7. A. O. Siefker-Radtke
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  8. G. Sonpavde
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  9. G. D. Steinberg
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  10. C. N. Sternberg
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  11. S. T. Tagawa
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  13. M. E. Woods
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  14. M. I. Milowsky
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Correspondence to M. I. Milowsky.

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Conflict of interest

MN Pham, AB Apolo, BC Leibovich, LL Pisters, AZ Weizer, ME Woods have no conflicts of interest. M De Santis has received research funding from Pierre Fabre Oncology and honoraria and consultation fees from Amgen, Astellas, Bayer, Celgene, Dendreon, Eisai Inc., ESSA, Ferring, GSK, Janssen Cilag, Merck, Novartis, Pfizer, Pierre Fabre Oncology, Roche, Sanofi Aventis, Shionogi, Synthon, Takeda and Teva/OncoGenex; MD Galsky has received research funding (to institution) from Merck, Genentech, BMS, Celgene, Novartis, and Dendreon. He is a member of the advisory boards for Merck, Genentech, and Novartis; AO Siefker-Radtke is a consultant and scientific advisor for: AstraZeneca, Genentech, Janssen, Eisai, and Merck. She receives research funding (to institution) from Millenium/Takeda, Genentech, Janssen, and AstraZeneca; G Sonpavde receives research support from Onyx, Bayer, Merck, Celgene, Pfizer, and Boehringer-Ingelheim. He is on the advisory board and/or is a consultant for Merck, Genentech, Sanofi, Bayer, Pfizer, Agensys, Novartis, and Argos. He is an author for UpToDate and speaker for Clinical Care Options; GD Steinberg is a consultant, scientific advisor, and/or investigator for: Photocure, Taris Biomedical, Cold Genesys, Heat Biologics, Roche/Genentech, UroGen, Merck, Karl Storz, and Telesta; CN Sternberg is a consultant, scientific advisor, and/or investigator for Merck, BMS, Oncogenex, and Lilly; ST Tagawa has received honoraria from Sanofi, Astellas, Janssen, Dendreon, Bayer, and Genentech and research funding (to institution) from Sanofi, Astellas, Janssen, Genentech, Lilly, Dendreon, Progenics, Millennium, Amgen, Bayer, Rexahn, and Inovio; MI Milowsky has received research funding (to institution) from BIND Therapeutics, Dendreon, Exelixis, Johnson & Johnson, Mirati Therapeutics, Pfizer, Cerulean Pharma, Merck, Seattle Genetics, Acerta Pharma, BioClin Therapeutics, and Roche/Genentech.

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Pham, M.N., Apolo, A.B., De Santis, M. et al. Upper tract urothelial carcinoma topical issue 2016: treatment of metastatic cancer. World J Urol 35, 367–378 (2017). https://doi.org/10.1007/s00345-016-1885-4

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