Jeffrey J Leow1, William Martin-Doyle2, André P Fay3, Toni K Choueiri3, Steven L Chang1, Joaquim Bellmunt4. 1. Bladder Cancer Center, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA; Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 2. University of Massachusetts Medical School, Worcester, MA, USA. 3. Bladder Cancer Center, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA. 4. Bladder Cancer Center, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA. Electronic address: joaquim_bellmunt@dfci.harvard.edu.
Abstract
CONTEXT: The role of adjuvant chemotherapy (AC) or neoadjuvant chemotherapy (NC) remains poorly defined for the management of upper tract urothelial carcinoma (UTUC), although some studies suggest a benefit. OBJECTIVE: To update the current evidence on the role of NC and AC for UTUC patients. EVIDENCE ACQUISITION: We searched for all studies investigating NC or AC for UTUC in Medline, Embase, the Cochrane Central Register of Controlled Trials, and abstracts from the American Society of Clinical Oncology meetings prior to February 2014. A systematic review and meta-analysis were performed. EVIDENCE SYNTHESIS: No randomized trials investigated the role of AC for UTUC. There was one prospective study (n=36) investigating adjuvant carboplatin-paclitaxel and nine retrospective studies, with a total of 482 patients receiving cisplatin-based or non-cisplatin-based AC after nephroureterectomy (NU) and 1300 patients receiving NU alone. Across three cisplatin-based studies, the pooled hazard ratio (HR) for overall survival (OS) was 0.43 (95% confidence interval [CI], 0.21-0.89; p=0.023) compared with those who received surgery alone. For disease-free survival (DFS), the pooled HR across two studies was 0.49 (95% CI, 0.24-0.99; p=0.048). Benefit was not seen for non-cisplatin-based regimens. For NC, two phase 2 trials demonstrated favorable pathologic downstaging rates, with 3-yr OS and disease-specific survival (DSS) ≤ 93%. Across two retrospective studies investigating NC, there was a DSS benefit, with a pooled HR of 0.41 (95% CI, 0.22-0.76; p=0.005). CONCLUSIONS: There appears to be an OS and DFS benefit for cisplatin-based AC in UTUC. This evidence is limited by the retrospective nature of studies and their relatively small sample size. NC appears to be promising, but more trials are needed to confirm its utility. PATIENT SUMMARY: After a comprehensive search of studies examining the role of chemotherapy for upper tract urothelial cancer, the pooled evidence shows that cisplatin-based adjuvant chemotherapy was beneficial for prolonging survival.
CONTEXT: The role of adjuvant chemotherapy (AC) or neoadjuvant chemotherapy (NC) remains poorly defined for the management of upper tract urothelial carcinoma (UTUC), although some studies suggest a benefit. OBJECTIVE: To update the current evidence on the role of NC and AC for UTUC patients. EVIDENCE ACQUISITION: We searched for all studies investigating NC or AC for UTUC in Medline, Embase, the Cochrane Central Register of Controlled Trials, and abstracts from the American Society of Clinical Oncology meetings prior to February 2014. A systematic review and meta-analysis were performed. EVIDENCE SYNTHESIS: No randomized trials investigated the role of AC for UTUC. There was one prospective study (n=36) investigating adjuvant carboplatin-paclitaxel and nine retrospective studies, with a total of 482 patients receiving cisplatin-based or non-cisplatin-based AC after nephroureterectomy (NU) and 1300 patients receiving NU alone. Across three cisplatin-based studies, the pooled hazard ratio (HR) for overall survival (OS) was 0.43 (95% confidence interval [CI], 0.21-0.89; p=0.023) compared with those who received surgery alone. For disease-free survival (DFS), the pooled HR across two studies was 0.49 (95% CI, 0.24-0.99; p=0.048). Benefit was not seen for non-cisplatin-based regimens. For NC, two phase 2 trials demonstrated favorable pathologic downstaging rates, with 3-yr OS and disease-specific survival (DSS) ≤ 93%. Across two retrospective studies investigating NC, there was a DSS benefit, with a pooled HR of 0.41 (95% CI, 0.22-0.76; p=0.005). CONCLUSIONS: There appears to be an OS and DFS benefit for cisplatin-based AC in UTUC. This evidence is limited by the retrospective nature of studies and their relatively small sample size. NC appears to be promising, but more trials are needed to confirm its utility. PATIENT SUMMARY: After a comprehensive search of studies examining the role of chemotherapy for upper tract urothelial cancer, the pooled evidence shows that cisplatin-based adjuvant chemotherapy was beneficial for prolonging survival.
Authors: Mounsif Azizi; Salim K Cheriyan; Charles C Peyton; Beat Foerster; Shahrokh F Shariat; Philippe E Spiess Journal: Curr Treat Options Oncol Date: 2019-04-01
Authors: Matthew R Danzig; Katherine Mallin; James M McKiernan; Walter M Stadler; Srikala S Sridhar; Todd M Morgan; Bernard H Bochner; Cheryl T Lee Journal: Cancer Date: 2018-04-06 Impact factor: 6.860
Authors: Francesco Soria; Marco Moschini; Andrea Haitel; Gregory J Wirth; Jose A Karam; Christopher G Wood; Morgan Rouprêt; Vitaly Margulis; Pierre I Karakiewicz; Alberto Briganti; Jay D Raman; Solene-Florence Kammerer-Jacquet; Romain Mathieu; Karim Bensalah; Yair Lotan; Mehmet Özsoy; Mesut Remzi; Kilian M Gust; Shahrokh F Shariat Journal: World J Urol Date: 2016-06-07 Impact factor: 4.226
Authors: Bjarte Almås; Stein Øverby; Ole J Halvorsen; Lars A R Reisæter; Jørg Assmus; Birgitte Carlsen; Anders Loe; Christian Beisland Journal: World J Urol Date: 2019-05-23 Impact factor: 4.226
Authors: Atiqullah Aziz; Jakub Dobruch; Kees Hendricksen; Luis A Kluth; Andrea Necchi; Aidan Noon; Michael Rink; Florian Roghmann; Roland Seiler; Paolo Gontero; Wassim Kassouf; Shahrokh F Shariat; Evanguelos Xylinas Journal: World J Urol Date: 2017-01-10 Impact factor: 4.226