Investigators evaluate ctDNA for predicting muscle-invasive and non–organ-confined staging of UTUC

In this video, Heather L. Huelster, MD, describes the background for the recent European Urology study “Novel Use of Circulating Tumor DNA to Identify Muscle-invasive and Non–organ-confined Upper Tract Urothelial Carcinoma.” Huelster is an assistant professor of urology at Indiana University School of Medicine in Indianapolis.

Transcription:

Please describe the background for this study.

Upper tract urothelial carcinoma is notoriously challenging to stage prior to extirpation of the kidney and/or ureter. If you ask 10 urologists what their least favorite operation is, probably 1 of them would say ureteroscopic tumor biopsy and ablation. This is because our biopsies are often limited by poor visualization in the setting of friable upper tract tumors, and the ability to only obtain a small volume of tumor sample with ureteroscopic instruments. We're rarely able to demonstrate muscle invasion pathologically on these biopsies, and current imaging with CT urograms is really of limited utility as well. So we primarily rely on pathologic grade for management of these tumors. However, there are observational data to suggest that cisplatin-based neoadjuvant chemotherapy is associated with pathologic downstaging and confers a cancer-specific survival benefit for high-risk upper tract urothelial carcinoma or locally advanced stages. But determination of those patients that may benefit from this neoadjuvant chemotherapy is very challenging and made more important due to the fact that there's a proportion of patients that will no longer be eligible for cisplatin-based chemo based on their renal function after nephrectomy. So in this study, we sought to evaluate the utility of a non-invasive biomarker—ctDNA—in predicting muscle-invasive and non–organ-confined staging of upper tract urothelial carcinoma.

This transcript was edited for clarity.