There are two main types of refractory myeloma patients:
Primary refractory patients who never achieve a response and progress while still on induction chemotherapy.
Secondary refractory patients who do respond to induction chemotherapy but do not respond to treatment after relapse.
A subgroup of patients who do not achieve a response to induction chemotherapy have stable disease and enjoy a survival prognosis that is as good as that for responding patients.[1,2] When the stable nature...
The development of new instrumentation for endourological treatment of upper tract transitional cell cancer has provided new options for regional management of these cancers. Introduction of electrofulguration and resection instruments or laser probes either transureterally or percutaneously may permit destruction of a primary cancer. Introduction of cytotoxic agents has also been employed. Although a biopsy can be taken for staging purposes, the accuracy of this remains to be determined. The efficacy of treatment by these maneuvers has not been established.
Electroresection and fulguration or laser fulguration, if the tumor is superficial.
Any parenchymal sparing procedure (segmental resection; ureteroscopic or percutaneous resection/fulguration/laser destruction) if the renal unit is solitary or renal function is depressed.
Intrapelvic or intraureteral cytotoxic/immunotherapy. The dramatic successes that have been reported with intravesical cytotoxic (thiotepa, mitomycin, doxorubicin) or immunologic/inflammatory (BCG, interferon) therapy for superficial transitional cell cancers in the bladder have led to the occasional use of these agents in the treatment of upper tract cancers. Long-term follow-up of the results of such treatments has generally not been reported, and the efficacy of this approach cannot be assessed, largely because experience has been limited to those patients whose compromised clinical status (solitary kidney, renal failure, medical risks for surgery) may have influenced clinical outcome. The use of this approach will be limited by the extent of disease in the renal pelvis, the access that these agents may have to the area of disease, the sensitivity of the cancer being treated, and the adequacy and accuracy of initial tumor staging and continued monitoring.
Laser vaporization/coagulation. Transurethral and percutaneous access to the upper tract have permitted the use of laser therapy in the control of superficial upper tract transitional cell cancers. This approach is dependent on accurate staging and adequate visualization of the lesions that need to be coagulated. Results of this approach are at present too preliminary to assess. Therapeutic efficacy, however, will depend on staging accuracy on initial treatment and ease of monitoring such patients for disease recurrence and possible progression.
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with localized transitional cell cancer of the renal pelvis and ureter. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.