AUA 2017: Efficacy of Chemotherapy Administration in Elderly Patients with Metastatic Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy

Boston, MA ( Our colleagues from Japan, lead by Dr. Shigeta, presented their findings of efficacy of chemotherapy administration in elderly patients with metastatic UTUC after radical nephroureterectomy (RNU) at this today’s UTUC poster session at the 2017 AUA Annual meeting. Given that these are typically cisplatin-based regimens, these patients may face obstacles to receiving chemotherapy in this setting, namely secondary to their age and only having a solitary kidney.

The authors identified 226 patients who developed disease recurrence after RNU over the last 15 years at 14 Japanese institutions. Cox proportional hazards modelling was used to identify factors that were related to cancer-specific survival (CSS) and overall survival (OS), adjusted for clinicopathological variables. A subgroup analysis was also performed determining the efficacy of systemic chemotherapy in patients >75 years of age. After disease recurrence, 145 patients underwent chemotherapy while the remaining 81 received no systemic treatment. Patients >75 years of age had poorer performance status (P<0.001) and bone metastasis at the time of disease relapse (p = 0.028) compared with the younger patients. Furthermore, receipt of chemotherapy was less likely amongst older patients (14.8% patients >75 years vs. 42.1% patients <75 years, P<0.001). Salvage chemotherapy on multivariable survival analysis was independently associated with CSS and OS, in addition to poor performance status, presence of liver metastasis, number of recurrence sites, and lymph node involvement in RNU specimens; age was not statistically significant. CSS rates for patients treated with chemotherapy was 41.8% at 1 year and 18.6% at 2 years, while those that were observed had poor outcomes of 10.2% and 6.8%, respectively. In the subgroup analysis, there was no significant difference in the clinicopathological backgrounds among patients who received chemotherapy (n = 38) and those who were observed (n = 43). Similar CSS and OS findings to the overall cohort were noted in the subgroup analysis. The strength of the study is the multi-institutional collaboration allowing feasibility of analysis for this unique subset of patients with UTUC. A limitation of this study is that competing risks analysis was not performed for CSS, which should be strongly considered given this comorbid population specifically over the age of 75.

The authors concluded that survival rates are improved for patients receiving systemic chemotherapy and that age should not be a driving force when deciding patients suitable for adjuvant treatment.

Speaker: Keisuke Shigeta, Keio University School of Medicine, Tokyo, Japan

Co-Authors: Eiji Kikuchi, Keishiro Fukumoto, Nozomi Hayakawa, Takeo Kosaka, Akira Miyajima, Mototsugu Oya

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre
Twitter: @zklaassen_md

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA