UCSD Health offers treatment for urinary tract cancer that could prevent dialysis and kidney transplant

In September, the first round of a new treatment for low-grade upper tract urothelial cancer (LG-UTUC) was completed for a patient at UC San Diego Health.

Doctors at UCSD Health are now administering Jelmyto, the first drug approved by the Food and Drug Administration for LG-UTUC. Jelmyto is a combination of mitomycin, an established chemotherapy drug, and hydrogel, a water-soluble polymer developed for use in humans. This particular hydrogel is a liquid when cold, but a gel at body temperature, allowing doctors to deliver the cold medication in liquid form through a catheter. The drug then solidifies into a gel and stays in the treatment area for 4-6 hours.

LG-UTUC is a subtype of upper tract urothelial cancer that is less likely to spread to other parts of the body. Although metastasis, the spread of cancer in the body, is usually not a problem for this type of cancer, it can still cause problems in the urogenital tract by blocking the flow of urine.

These tumors are found in the epithelium of the kidneys and ureter, the tubes connecting the kidneys to the bladder. The standard of care for these tumors is often radical nephroureterectomy, which involves removing the kidney, ureter, and part of the bladder. Although there are alternative treatments to save the kidneys, such as endoscopic tumor removal – the removal of a tumor using a small camera – the urogenital tract is complex, which makes this difficult procedure.

In addition, each of these treatment methods – RNU and endoscopic tumor removal – has associated risks. URN is associated with long-term decreased kidney function and the development of chronic kidney disease, which is a risk factor for hospitalization, heart disease, and death. Endoscopic tumor removal has higher cancer recurrence rates than RNU.

Dr. Aditya Bagrodia, associate professor of urology and head of genitourinary oncology at UCSD Health, praised the work of UCSD health workers in making this treatment possible.

Bagrodia noted, “The required coordination of the cancer center, pharmacy, operating room, and urology administrative staff and the Herculean efforts of each of these parties is what makes this possible. a lot of work, but it is worth it for our patients.

According to Jelmyto’s website, the drug has been shown to be remarkably effective, as “58% of patients saw their tumors disappear after treatment with Jelmyto”, and one year after treatment, the majority of patients whose tumors disappeared were still cancer free. The effectiveness of Jelmyto makes endoscopic tumor removal using Jelmyto a more viable alternative to RNU.

Jelmyto is a great option for patients because it offers LG-UTUC patients the chance to preserve one of their kidneys. This further prevents other complications associated with kidney ablations such as dialysis, kidney transplant, and kidney disease.

While it’s too early to tell how effective the treatment will be for patients at UCSD Health, Bagrodia is “optimistic that our patients will do well.”

Jelmyto was approved for use by the FDA in April 2020, but the rarity of the disease and an intensive drug administration schedule delayed its use at UCSD. According to the FDA, 6,000 to 8,000 cases of LG-UTUC are diagnosed each year in the United States. UTUC affects approximately 2 people per 100,000 people each year, and LG-UTUC accounts for 30% of UTUC patients.

Illustration by Allen Chen for the UCSD Guardian

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