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Urologic Cancer COVER STORY New Chemo Vector Offers Option for Patients with Difficult to Treat Urologic Cancer STORY HIGHLIGHTS A new approach to treating upper-tract urothelial cancer has the potential to improve the delivery of chemotherapy drugs and to reduce the number of patients who lose a kidney as part of their treatment. The approach delivers topical chemotherapy using a vector that is liquid at room temperature but becomes a gel at body temperature, solidifying in the renal pelvis and ureter to increase exposure time. (continued from cover) into the “sink” — the renal pelvis, ureter and bladder. For patients with upper-tract urothelial cancer — cancer that resides in the renal pelvis and ureter — recurrence is common after endoscopic surgery, and topical chemotherapy isn’t an option because the ureters drain the liquid chemo into the bladder almost immediately, preventing any meaningful contact between the chemo and the tumor. “The ureters are tubes that we can access only from the bottom, and when you squirt fluid up into the ureter, it just drains right out,” explains Nicholas Donin, MD, urologic-oncology fellow in the UCLA Department of Urology. “We haven’t had a way to keep the medicine up there. “For patients with low-grade tumors that do not appear amenable to complete endoscopic treatment, this technology has the potential to save their kidney from having to be removed.” As a result, we haven’t been able to treat these tumors with topical chemotherapy, even though we know that in the bladder, these drugs are effective.” Although some patients with low-risk disease and favorable characteristics can be effectively treated endoscopically, he notes, most require radical nephroureterectomy — surgical removal of the kidney and ureter. Dr. Donin is part of a UCLA urology team headed by Karim Chamie, MD, that has conducted a series of studies of a new approach to delivering topical chemotherapy to these tumors using a vector that is liquid at room temperature but becomes a gel at body temperature. A mixture of the liquid gel and chemotherapy drugs is injected into the renal pelvis and ureter, where it solidifies and takes on the shape of the cavity, enabling the course of chemotherapy exposure to last several hours rather than seconds to minutes. The UCLA team recently completed a three- phase preclinical study evaluating the safety and technical feasibility of instilling the chemotherapy-impregnated gel in the upper urinary tract of a live-animal model. Among the findings, published in the journal Urology: The gel remained within the renal pelvis and Photo: Getty Images UCLAHEALTH.ORG 1-844-4UCLADR (1-844-482-5237)