One Size Fits Some: Approaching Rare Malignancies of the Urinary Tract

Curr Treat Options Oncol. 2024 Feb;25(2):206-219. doi: 10.1007/s11864-024-01187-3. Epub 2024 Feb 5.

Abstract

Urothelial carcinoma is the predominant cancer of the urinary tract but when divergent and subtype histology (non-urothelial) are identified at time of pathologic diagnosis, therapeutic and diagnostic challenges transpire. To this end, pathologic review to confirm any non-urothelial histology is key since these subtypes can often be overlooked. Few prospective trials are dedicated to understanding these non-urothelial histologic types; however, current, and past trials did allow patients with these non-urothelial histologic types to enroll, and inferences can be made about treatment efficacy and survival. Existing treatment regimens for non-urothelial bladder cancers are akin to standard urothelial cancer regimens using surgical approaches for localized disease and platinum-based chemotherapy for advanced disease. The reported clinical trials, that will be discussed, center on non-urothelial histologic types. These studies, albeit limited, provide critical insight into tumor biology and response to standard platinum-based chemotherapy, immune checkpoint inhibitors, and antibody drug conjugates. The inclusion of non-urothelial histologic types will be essential for clinical trials in development to provide further therapeutic advances and provide essential efficacy data.

Keywords: Divergent and subtype histology; Genitourinary tumors; Urothelial carcinoma.

Publication types

  • Review

MeSH terms

  • Carcinoma, Transitional Cell* / drug therapy
  • Humans
  • Prospective Studies
  • Treatment Outcome
  • Urinary Bladder Neoplasms* / diagnosis
  • Urinary Bladder Neoplasms* / etiology
  • Urinary Bladder Neoplasms* / therapy
  • Urinary Tract* / pathology