title: Upper tract urothelial carcinoma topical issue 2016: treatment of metastatic cancer.
abstract: OBJECTIVE
  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.
authors.affiliation: University of North Carolina School of Medicine, Chapel Hill, NC, USA.
authors.forename: M N
authors.initials: MN
authors.lastname: Pham
authors.affiliation: National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: A B
authors.initials: AB
authors.lastname: Apolo
authors.affiliation: Cancer Research Unit, University of Warwick, Coventry, UK.
authors.forename: M
authors.initials: M
authors.lastname: De Santis
authors.affiliation: The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: Galsky
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors.forename: B C
authors.initials: BC
authors.lastname: Leibovich
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: L L
authors.initials: LL
authors.lastname: Pisters
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: A O
authors.initials: AO
authors.lastname: Siefker-Radtke
authors.affiliation: University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL, USA.
authors.forename: G
authors.initials: G
authors.lastname: Sonpavde
authors.affiliation: Section of Urology, Department of Surgery, The University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: G D
authors.initials: GD
authors.lastname: Steinberg
authors.affiliation: San Camillo and Forlanini Hospitals, Rome, Italy.
authors.forename: C N
authors.initials: CN
authors.lastname: Sternberg
authors.affiliation: Weill Cornell Medicine, New York, NY, USA.
authors.forename: S T
authors.initials: ST
authors.lastname: Tagawa
authors.affiliation: Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: A Z
authors.initials: AZ
authors.lastname: Weizer
authors.affiliation: Department of Urology, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Woods
authors.affiliation: 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. matt_milowsky@med.unc.edu.
authors.forename: M I
authors.initials: MI
authors.lastname: Milowsky
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000008:administration & dosage; D016190:Carboplatin / Q000008:administration & dosage; D002295:Carcinoma, Transitional Cell / Q000556:secondary / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077143:Docetaxel; D006801:Humans; D007167:Immunotherapy; D007211:Indoles / Q000008:administration & dosage; D007680:Kidney Neoplasms / Q000473:pathology*; D007682:Kidney Pelvis; D009536:Niacinamide / Q000008:administration & dosage / Q000031:analogs & derivatives; D017239:Paclitaxel / Q000008:administration & dosage; D010671:Phenylurea Compounds / Q000008:administration & dosage; D011758:Pyrroles / Q000008:administration & dosage; D000077157:Sorafenib; D000077210:Sunitinib; D043823:Taxoids / Q000008:administration & dosage; D014516:Ureteral Neoplasms / Q000473:pathology*; D000093542:Gemcitabine
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D007211:Indoles; D010671:Phenylurea Compounds; D011758:Pyrroles; D043823:Taxoids; D003841:Deoxycytidine; D000077143:Docetaxel; D009536:Niacinamide; D000068258:Bevacizumab; C000594389:atezolizumab; D000077157:Sorafenib; D016190:Carboplatin; C582435:pembrolizumab; C000609138:avelumab; D017239:Paclitaxel; D002945:Cisplatin; D000077210:Sunitinib; D000093542:Gemcitabine
keywords: Anti-PD-1; Anti-PD-L1; Chemotherapy; Immune checkpoint inhibitors; Immunotherapy; Targeted therapy; Upper tract urothelial carcinoma (UTUC)