Neoadjuvant chemotherapy (NAC) can lead to tumor downstaging and better survival for some patients with nonmetastatic upper tract urothelial carcinoma (UTUC), according to new study findings published in the Canadian Journal of Urology.
Using the National Cancer Database 2004 to 2015, Zachary Hamilton, MD, of Saint Louis University in Missouri, and collaborators identified 3634 non-metastatic, stage II-IV UTUC patients (node positive disease allowed) undergoing radical nephroureterectomy. Of these, 270 received NAC. On average, NAC patients were younger than patients who did not receive chemotherapy (age 67 vs 74 years) and had less comorbidity based on Charlson Comorbidity scores. The expected delay in surgical intervention from NAC was 139 days.
Compared with the no chemotherapy group, patients receiving NAC had a significantly higher rate of downstaging to non-invasive disease (10.7% vs 1.7%). In a propensity score matched analysis of 532 patients, the rates were 10.9% vs 3.8%, respectively. NAC recipients were 6-fold more likely to have downstaging than patients not receiving chemotherapy.
Median overall survival was 44.8 vs 27.3 months for the NAC and no chemotherapy groups, respectively. Cox regression analyses also showed a significant 33% lower risk for death with NAC. Even after propensity score analysis, the risk for death was reduced by a significant 39% with NAC.
“While NAC may not be feasible or warranted for all patients with UTUC, the current data available suggests well selected patients may be downstaged to non-invasive disease and can derive long term survival benefits,” Dr Hamilton told Renal & Urology News. “These findings echo outcomes for urothelial cell carcinoma of the bladder. Future efforts should focus on determining which patients derive the most survival benefits in the neoadjuvant setting.”
The National Cancer Database does not specify chemotherapy regimens, which precludes some analyses.
Davaro F, May A, McFerrin C, et al. Chemotherapy increases survival and downstaging of upper tract urothelial cancer. Canadian J Urol. 26(5).