ASCO GU 2020: The Efficacy of Two Cycles of Neoadjuvant Chemotherapy for Upper Tract Urothelial Carcinoma Patients.

San Francisco, CA (UroToday.com) Upper tract urothelial carcinoma (UTUC) is frequently upstaged after surgery and is associated with poor prognosis. There is retrospective data showing that neoadjuvant chemotherapy induced pathological downstaging and at times, pathological complete response with improved clinical outcomes. Most of these studies reported using 4 or more cycles of neoadjuvant chemotherapy. In this presented poster, the authors evaluated whether 2 cycles of neoadjuvant chemotherapy are sufficient and can improve survival of UTUC patients.

A total of 167 patients underwent radical nephroureterectomy between 2005 and 2018 and were retrospect analysed. The study population eventually included 114 patients who underwent radical nephroureterectomy who received neoadjuvant chemotherapy followed by surgery. The control group consisted of 53 patients who underwent surgery without neoadjuvant chemotherapy.  The study design is shown in Figure 1 and patient characteristics are demonstrated in Table 1.

study design

Figure 1. Study design

Table 1. Patient characteristics

ASCOGU_PatientCharacteristics_Abstract505.png

Table 2 demonstrates the clinical and pathological tumor characteristics and Table 4 shows the neoadjuvant chemotherapy regimens that were administered.

Table 2 — Clinical and Pathological Tumor Characteristics: 
ASCOGU_ClinicalPathologicalTumor_Abstract505.png

Table 4 — Neoadjuvant Chemotherapy Regimens: 

ASCOGU_NACregimens_Abstract505.png

Table 5 shows the multivariable Cox model for overall survival. Figure 1-6 demonstrate the Kaplan Meier curves for overall survival (OS), cancer specific survival (CSS) and recurrence free survival (RFS).

Table 5 — Multivariable Cox Model for OS: 
ASCOGU_Univariate_MultivariateCoxModel_Abstract505.png

Figures 1-6 — Kaplan Meier Curves for OS, CSS, RFS: 

ASCOGU_Figures1-6_KaplanMeir_Abstract505.png

Based on these results, the authors concluded the two cycles of neoadjuvant chemotherapy can potentially improve survival of UTUC patients. The usage of 2 instead of 4 cycles of neoadjuvant chemotherapy may offer additional clinical benefits which include low chemotherapy associated toxicity, appropriate surgery without delay in cases of chemo resistant disease, and enough cancer regression.

However, further prospective studies are needed to identify the clinical benefit of neoadjuvant chemotherapy and the optimal number of the cycles required in UTUC. 

Presented by: Kenji Zennami, MD, PhD, Fujita Health University, Tokyo, Japan

Written By: Hanan Goldberg, MD, Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA, Twitter: @GoldbergHanan, at the 2020 Genitourinary Cancers Symposium, ASCO GU #GU20, February 13-15, 2020, San Francisco, California

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