“POUT IS an impressive study, given that the authors were able to complete a trial in this relatively rare cancer. We still need overall survival data to determine the role of adjuvant chemotherapy for upper tract urothelial cancer. We need to know if it makes people live longer or have a better quality of life,” said ASCO Expert Timothy Gilligan, MD, of the Cleveland Clinic.

Timothy Gilligan, MD

“If postoperative chemotherapy does not result in longer survival, then treating at relapse makes more sense: Fewer patients are exposed to chemotherapy and its toxicities if we treat at relapse,” he added.

“One challenge with postoperative chemotherapy is that cisplatin is the most important agent, and it requires normal kidney function. After nephro-urectomy, patients have only one kidney, and some are not eligible for cisplatin due to reduced renal function. Therefore, my practice is to give chemotherapy before surgery [ie, neoadjuvant chemotherapy] based on studies showing an overall survival benefit with this approach in urothelial carcinoma of the bladder,” he commented.

“One reason the POUT study is important is that it shows that upper urinary track urothelial carcinoma is responsive to chemotherapy. Many of us have wondered if the benefit of perioperative chemotherapy we see with bladder cancer would also be seen in upper tract tumors. For oncologists who were not already giving perioperative chemotherapy for upper tract disease, this study should make them reconsider. However, the POUT study does not evaluate neoadjuvant vs adjuvant chemotherapy, and there are reasons (noted above) why many of us prefer to give chemotherapy before surgery,” Dr. Gilligan noted. ■

DISCLOSURE: Dr. Gilligan reported no conflicts of interest.