Page 11 - Canadian Urological Association/Genitourinary Medical Oncologists of Canada consensus statement: Management of unresectable locally advanced and metastatic urothelial carcinoma

CUAJ – Consensus Statement Warren et al
Unresectable locally advanced and metastatic urothelial carcinoma

Patients for whom multidisciplinary input may be useful include those with oligometastatic
disease, advanced pelvic disease (without hematogenous metastases) with a response to systemic
therapy, and those with hematogenous metastases with a complete response at least pertaining to
their metastatic disease.

Future directions
The management of locally advanced and metastatic urothelial carcinoma is a rapidly changing
field. Ongoing randomized phase III studies of immunotherapy for advanced urothelial
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carcinoma are summarized in Table 5. Additionally, work is being done on identifying
predictive biomarkers which will help in patient selection. Upper tract urothelial carcinoma is
associated with microsatellite instability in 3 – 6% of cases and this may be a useful biomarker to
evaluate with respect to the efficacy of immunotherapy. 73,74 The association with Lynch
syndrome should be noted and the role of universal screening versus risk adapted screening
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could be evaluated in subsequent updates. Immunotherapy studies are also taking place in the
earlier stages of disease which has the potential to alter the profile of the patient presenting with
subsequent locally advanced or metastatic disease. Immunotherapy may also change the profile
of patients being considered for aggressive local therapies in the context of metastatic disease.
Due to the rapid evolution of therapy in this disease state, these consensus statements will need
regular updating.