Urologic oncologist at UC San Diego Health, Amirali Salmasi, MD talks about a new, non-invasive way to treat urinary tract cancer.
Interview conducted by Ivanhoe Broadcast News in 2023.
Can you tell us what upper tract is?
Salmasi: Sure. So upper tract involves the lining of the renal pelvis of the kidney and the ureter all way down to the bladder. It’s a rare form of the urothelial carcinoma and just considers about the 7-10% of the older urothelial carcinoma and I think on an average, one to two in 100,000 patients per year develop with the upper tract urothelial carcinoma.
And so it’s in the kidney and the bladder, and the tube that connects the kidney and the bladder?
Salmasi: So the urothelial cell is just a lining of the renal pelvis in the kidney, the ureter all the way down and in the lining inside of the bladder. When we call upper tract involves the lining of the inside of the kidney and the ureter.
Well, first of all, tell me what a patient’s experience is when they have this.
Salmasi: That’s a good question. It depends on the location and the size of tumor and we can diagnose or manage endoscopically means that can go with the camera through to the bladder and all the way up. But because of these cameras are small and using laser and it’s very small, working channel is not easy to manage if the size of the tumor is large. Most of the times at the end of these people, they lose the kidneys or the part of the ureters and by doing that they usually have multiple medical problems. They are not healthy from the beginning and they push them towards a chronic kidney disease. Sometimes we get dialysis and on a nature wise this cancer is compared to the bladder cancer usually has a more aggressive nature.
What are the symptoms of someone who would have this?
Salmasi: They usually people develop some blood in the urine that’s like a bladder and microscopically or cross immaterial. If it cause blockage of the kidney, they might develop some pain. You know what again, depends on what stage we diagnose the disease, but most of the time they were diagnosed with some little bit blood in the urine or visibly blood.
Is the traditional treatment for this removal of the kidney then?
Salmasi: If we cannot manage it endoscopically because of the size and it’s very hard? Yes. Every time we talk about the cancer, we have to mention two things we call high grade low grade is aggressive form, slow growing or fast growing. For a high grade urothelial upper tract, most of the times we offer the surgically remove the kidney. If it’s a small area, the lower part of the ureter we can remove only that part but most of the times these people end up losing the kidney and then when we say for upper tract is not only the kidney, we cut the kidney, the ureter all the way down and the part of the bladder connection of the ureter and the bladder.
But now for the low grade one, there’s a brand new FDA approved drug?
Salmasi: Yes.
And how does it work?
Salmasi: So one of the challenges we have for upper track compared to the bladder. Bladder, we can fill the bladder and it just stays there. For upper track is not the easy way to fill with the chemo drugs or some immuno modulating drug and stays there. This new drug called Jelmyto is a chemo drug called mitomycin that material when it’s in the cold, it’s a liquid. When we put in the body temperature, it forms a gel and it stays there and with the time gets liquefied, and just come out from the body. This gel we call Jelmyto it’s approved for a low grade small tumors of the upper tract. It’s very exciting news for people because we can just give this medication once a week for six weeks and they come and we just administer there and that this chemo drug absorb slowly on that area and then it does their magic. I think it changed the field significantly for the people with the low grade upper tract disease.
Could you be more specific, how that changed the field?
Salmasi: Sure. So for these people, most of the times, even their low rate or small, we had to go multiple times, use a laser to go appalachation to burn it and sometimes it’s okay, it’s not working we have to remove the kidney. But with this drug, we have based on the trial Olympus trial, they have about 60% that trial complete response on the small low grade renal mass less than 1.5 centimeter. But in the real world data also, they had a very good success rate by giving that, we are hoping to prevent multiple surgeries because every time we do surgery, surgery comes with the risk of the surgery and the complication and risk involved with that surgery and also decreases significantly chance of removing the kidney. Of course the consequences goes to dialysis and all these things can happen.
And this drug, Jelmyto, do you inject it directly into the area from the outside?
Salmasi: It’s a nephrostomy tube. We place that tube and it stays for the duration of the treatment. We give it like once a week for six weeks. Then the people come to the clinic from that tube, we just administer the drug directly to the kidney and they fill that track. Second way to administer this drug is a retrograde. Retrograde requires every time patient comes to the clinic, we go with the camera into the bladder. We put a temporary tube from the bladder in the ureter, and then the administered drug and the remove it. If we find that the time is easier, we give it directly from the kidney because it doesn’t need every time we manipulate they put to place the tube and all the intervention. The second things about that, one of the risk and the side effects of this Jelmyto, is stricture. Stricture of the ureter and there is a data that shows that if we give it like antegrade from the tube that comes down has a less chance of up stricture. We prefer for our patient’s comfort and possibly the lesser risk of a stricture give it antegrade.
And are there any other side effects?
Salmasi: There’s always a risk of the urinary infection because we manipulate the system. The most common side effects after the infection is urethral stricture and of course could be a discomfort, pain always can happen. There are some reports that as long as there is no opening or perforation on the system, people usually, they don’t develop any symptoms. But if it’s any perforation that this chemo drug can go outside of the system, there’s always possibility of the risk.
You treat this a lot. Are you excited about this drug?
Salmasi: Yeah, we are very excited at this drug and we are giving in, on the people especially not every patient can tolerate the surgery. Some people bringing them to the operating room multiple times these are not the people on a younger age. Usually it’s like an older age, multiple medical problem and by doing that, we decrease the operation risks and they are happy. They just come there for a 15, 20 minutes we administer this drug and they go. I’m very excited and we are happy we have this drug here yet.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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