While neoadjuvant chemotherapy appears beneficial in high-risk upper tract urothelial carcinoma (UTUC), some patients do not receive it due to their preference or limited insurance coverage. For these patients, adjuvant chemotherapy may improve survival over radical nephroureterectomy alone, a new study finds.

In a meta-analysis of 11 studies published 2009 to 2019 (mostly from Asia), a total of 798 patients with T3 to 4 or node-positive UTUC received adjuvant chemotherapy after radical nephroureterectomy (RNU) and 1496 patients underwent RNU alone. Adjuvant chemotherapy patients had a significant 41% and 27% risk reduction in disease recurrence and cancer-specific death, respectively, compared with patients only undergoing surgery, Kang Su Cho, MD, PhD, of Gangnam Severance Hospital in South Korea, and colleagues reported in Clinical Genitourinary Cancer. Improvement in overall survival was a nonsignificant 16%.

Previously reported meta-analyses included UTUC patients of all stages and found adjuvant chemotherapy improved disease-free survival, but not cancer-specific (CSS) or overall survival.

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“The current study is the first to discover that the beneficial effects of ACH [adjuvant chemotherapy] on CSS might be greater for patients with locally advanced UTUC,” Dr Cho’s team stated. “This would be of great benefit to patients and clinicians who are discussing the use of ACH after surgery for locally advanced UTUC.”

The adjuvant chemotherapy regimens varied across studies. According to the researchers, research is still needed to determine the specific role of adjuvant chemotherapy in patients with locally advanced UTUC.

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Kim DK, Kim JW, Jung HD, et al. Effects of adjuvant chemotherapy on locally advanced upper tract urothelial carcinoma: A systematic review and meta-analysis [published online August 22, 2019]. Clin Genitourin Cancer. doi: 10.1016/j.clgc.2019.08.010