upper urinary tract cancer - 1261273

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upper urinary tract cancer - 1261273

my husband has had noninvasive bladder cancer for 28 years, recently had a radical nephrouterectomy for stage 3 ureter cancer. chemo is recommended , but his creatinine is 1.7.we have seen various studies ,some saying chemo does not work ,others saying that it does. Do you have information about the effectiveness of chemotherapy for this type of cancer, since the doses will have to be modified since he has only one kidney. and what is the determinant level of creatine that would prevent chemotherapy from being given.

Reply To: upper urinary tract cancer

Hello lilady, I'm sorry you and your husband are having a tough time finding the best options for your husband. I don't know that our bladder cancer specialist will have the info you're looking for but I'll ask for his input.

All best to you and him,

Dr West
Reply To: upper urinary tract cancer

Although this is a relatively rare type of cancer, I see a patient or two in this situation every year. I'm not aware of any significant evidence in meaningful populations of such people to guide any evidence-based recommendations. It really ends up coming down to best clinical judgment for individual patients.

The vast majority of people with ureteral cancer undergo a nephroureterectomy, which means that these people as a rule have one kidney and compromised renal function. Because transitional cell carcinoma is often very responsive to chemotherapy, I am very inclined to give chemotherapy, but I am rarely inclined to give cisplatin and gemcitabine, since cisplatin is likely to worsen kidney function, but I consider carboplatin/gemcitabine to be the best intersection of potential efficacy and anticipated safety.

This isn't to say that this is the only way to approach such a situation, and one might also consider the combination of Taxol (paclitaxel) and gencitabine or single agent chemotherapy, There isn't a clear prevailing strategy that should be considered dogma here.

Good luck.

-Dr. West

Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

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