Use of neoadjuvant and adjuvant chemotherapy for upper tract urothelial carcinoma (UTUC) is increasing in the United States, but it remains uncommon and inconsistent among different patient populations and treatment centers, researchers concluded in a presentation at the Society of Urologic Oncology 17th annual meeting in San Antonio, Texas.
Using information from the National Cancer Database, Benjamin McCormick, MD, and colleagues at the University of North Carolina in Chapel Hill found that the proportion of UTUC patients who underwent nephroureterectomy and received neoadjuvant chemotherapy (NAC) rose from 0.6% during 2004–2007 to 1.5% during 2008–2010 and 2.7% during 2011–2013. The proportion who received adjuvant chemotherapy (AC) increased from 7.4% to 12.6% and 13.1% during those periods, respectively.
The study included 2,018 patients who underwent nephroureterectomy during 2004–2007, 2,118 during 2008–2010, and 2,320 during 2011–2013.
Among patients who did not receive chemotherapy, male patients were more likely than female patients not to receive it based on risk factors (49.0% vs 39.2%) and women were more likely than men to refuse chemotherapy (60.8% vs 51.0%).
NAC and AC use varied by geographic location. In the Northeast, Southeast, West, and Midwest, clinicians used NAC in 1.7%, 1.0%, 2.6%, and 1.4% of cases, respectively, and AC in 12.4%, 10.5%, 10.6%, and 11.3% of cases, respectively. NAC and AC use also varied by type of hospital. For example, NAC use was highest at academic centers (2.7% of cases) and lowest in community hospitals (0.5%).
Patients who did not receive chemotherapy lived a median 11 miles from their treatment center compared with 19.5 miles for patients received NAC and 40.4 miles for those receiving both NAC and AC, according to the researchers.
“We are encouraged that the trend in NAC is increasing, but there is a lot of room for improvement, not only within the community, but at academic centers as well,” Dr McCormick told Renal & Urology News. “The results, especially in regard to patient refusal and distance traveled for treatment, have created new questions which we are excited to investigate further.”
McCormick B, Deal A, Filippou P, et al. Trends in the use of chemotherapy for treatment of upper tract urothelial carcinoma using the National Cancer Database. Presented at the Society of Urologic Oncology 17th annual meeting, San Antonio, Texas. Poster 70.