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Thomas Flaig, MD


SUO 2023: Multi-institutional Analysis of Neoadjuvant Chemotherapy for Urothelial Cancer

By: Joshua Swore, PhD
Posted: Wednesday, December 27, 2023

For patients with upper tract urothelial carcinoma, the use of neoadjuvant chemotherapy before a radical nephroureterectomy compared with operative intervention alone may improve the odds of achieving a pathologic complete response, according to a presentation given at the 2023 Society for Urologic Oncology (SUO) Annual Meeting (Poster 57). These findings should spearhead the development of additional randomized studies evaluating the benefit of neoadjuvant chemotherapy in this patient population, suggested Nicholas Corsi, MD, of UT Southwestern Medical Center, Dallas, and colleagues.

“This is one of the largest multinational experiences of neoadjuvant chemotherapy in upper tract urothelial carcinoma to date,” stated the study authors.

From 2011 to 2022, a total of 1,107 patients with upper tract urothelial carcinoma were recruited from 13 high-volume treatment centers for the study. Patients either received neoadjuvant chemotherapy with radical nephroureterectomy (n = 72) or radical nephroureterectomy alone (n = 1,035). The neoadjuvant chemotherapy regimen consisted of either gemcitabine plus cisplatin (61%) or dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (24%). Pathologic and clinical data were collected from all patients to evaluate clinical outcomes.

The study authors reported improved pathologic complete response rates in patients treated with neoadjuvant chemotherapy and radical nephroureterectomy (odds ratio [OR] = 2.49). Furthermore, evidence of nodal downstaging was most prominent in patients who were administered neoadjuvant chemotherapy (OR = 9.56). Moreover, despite the notable difference in the number of patients within each treatment group, the standardized differences between the groups were less than 0.1, suggesting strong matching, according to the presenters.

Disclosure: No information regarding conflicts of interest was provided.

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