Neoadjuvant Chemotherapy Prior to Surgery Improves Outcomes in UTUC

WASHINGTON, DC—Neoadjuvant chemotherapy plus radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) increases the likelihood of pathologic complete response and nodal downstaging compared with RNU alone, according to real-world data presented at the Society of Urologic Oncology’s 24th Annual Meeting.

The data, presented by Nicholas Corsi, MD, a resident at UT Southwestern Medical Center in Dallas, Texas, are from a multinational matched-pair analysis comparing pathologic complete response and nodal downstaging rates between patients treated with neoadjuvant chemotherapy (NAC) plus RNU and those treated with RNU alone. The study is one of the largest experiences of NAC in UTUC to date, according to the investigators. 

“The impetus for this project is that there is currently no level 1 evidence to support neoadjuvant chemotherapy for upper tract urothelial carcinoma,” Dr Corsi said in an interview.

For the study, Dr Corsi’s team pooled data from 13 tertiary referral centers in the United States, Europe, and Asia. The investigators matched 72 patients who received NAC+RNU to 1035 who underwent RNU alone. The mean follow-up duration was 26.0 and 30.9 months, respectively.

The NAC+RNU group had a significant 2.5-fold increased likelihood of pathologic complete response and 9.6-fold increased likelihood of nodal downstaging compared with the RNU only group.

Dr Corsi said it is reassuring that NAC improves the likelihood of pathologic complete response compared with RNU alone.

The most common NAC regimen consisted of gemcitabine/cisplatin (61%), followed by ddMVAC (24%).

The new findings are in line with previous research suggesting that NAC prior to RNU is associated with improved outcomes. A meta-analysis of 22 studies and 15,378 patients with nonmetastatic UTUC demonstrated that NAC prior to RNU was significantly associated with a nearly 19-fold and 6.5-fold increased likelihood of pathologic complete response and pathologic downstaging, respectively, compared with RNU alone, according to a 2020 report in the International Journal of Clinical Oncology.

Reference

Corsi N, Stephens A, Eilender B, et al. Neoadjuvant chemotherapy (NAC) plus radical nephroureterectomy (RNU) vs. RNU alone for upper tract urothelial carcinoma: a multicenter IPTW-matched pair analysis (ROBUUST collaborative group). Presented at the Society of Urologic Oncology’s 24^th Annual Meeting; November 28-December 1. Poster 57.

This article originally appeared on Renal and Urology News