Adjuvant Chemotherapy Significantly Boosts Survival in Upper Tract Urothelial Cancer

Adjuvant chemotherapy significantly improves disease-free survival (DFS) for patients with muscle-invasive upper tract urothelial cancer (UTUC), according to study results published in the Journal of Clinical Oncology.

“Primary analysis of the POUT trial, demonstrating improved DFS, supports the use of adjuvant gemcitabine:platinum chemotherapy after nephroureterectomy for patients with muscle invasive upper tract urothelial cancer (renal pelvis or ureter, UTUC),” explained Alison Birtle, MD, MBBS, MRCP, FRCR, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom University of Manchester in Manchester, United Kingdom, University of Central Lancashire in Preston, United Kingdom, and coauthors. “At the time of initial publication, overall survival (OS) data, a key secondary end point, were immature. We present updated DFS and a prespecified final analysis of OS and other secondary end points,” they continued.

Updated results show that chemotherapy provides a marked DFS benefit, with a 5-year DFS rate of 62% in the chemotherapy group compared to 45% in the surveillance group. The risk of recurrence or death was reduced by 45% in patients receiving chemotherapy (hazard ratio [HR], 0.55; P =.001). Conducted across 57 centers, the POUT trial involved 261 patients, with 132 receiving chemotherapy and 129 under surveillance. Chemotherapy consisted of 4 cycles of gemcitabine combined with either cisplatin or carboplatin. After a median follow-up of 65 months, the trial demonstrated an 18-month improvement in DFS with chemotherapy. Additionally, metastasis-free survival (MFS) and disease-specific survival (DSS) results also supported the benefit of chemotherapy.

While there was a trend toward improved overall survival (OS) in the chemotherapy group, it did not reach statistical significance. The 5-year OS rate was 66% in the chemotherapy group compared to 57% in the surveillance group, with an 11-month OS improvement (HR, 0.68; P = .049). Adverse events and quality of life (QoL) assessments showed no significant differences between the 2 groups.

“In summary, updated outcomes from the POUT trial add further support to the value of adjuvant systemic gemcitabine:platinum combination chemotherapy after nephroureterectomy for UTUC,” concluded the study authors.

Reference

Birtle AJ, Jones R, Chester J, et al. Improved disease-free survival with adjuvant chemotherapy after nephroureterectomy for upper tract urothelial cancer: Final results of the POUT trial. J Clin Oncol. 2024;42(13):1466-1471. doi:10.1200/JCO.23.01659