- Email: [email protected]
Adjuvant chemotherapy for upper tract urothelial cancer
News
Use of adjuvant chemotherapy could boost overall survival for patients with locally advanced or positive regional lymph node urothelial carcinomas, new research suggests. Treatment options for this group of patients are limited, with radical nephroureterectomy the current standard of care for most patients. For this study, Thomas Seisen and colleagues (Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA) did an observational study using data from the National Cancer Database to compare the effectiveness of adjuvant chemotherapy versus observation in 3253 patients with node-positive upper tract urothelial carcinoma. 762 patients received adjuvant chemotherapy within 90 days of radical nephroureterectomy for upper tract urothelial carcinoma that was locally advanced stage pT3/T4, node positive,
or both, whereas the remaining 2491 patients were observed after radical nephroureterectomy. Patients who received adjuvant chemotherapy had longer overall survival than those who underwent observation. Median overall survival was 47·41 months (IQR 19·88–112·39) in the chemotherapy group and 35·78 months (IQR 14·09–99·22) in the observation group (p=0·001). Using inverse probability at treatment weighting analysis, the researches estimated 5 year overall survival to be 43·90% for the chemotherapy group and 35·85% for the observation group. Sumanta Kumar Pal (City of Hope Comprehensive Cancer Center, Duarte, CA, United States) said “Traditionally this is a population group that responds quite poorly to chemotherapy. Previous studies on the use of chemotherapy for this group of patients have been hampered by problems such as
selection bias. The findings of this study are compelling but they are no substitute for randomised trials. It is appropriate for clinicians to discuss chemotherapy with patients with upper tract urothelial carcinoma but my hope is that immunotherapy will improve survival for these patients. There are a number of trials already under way that are looking into this.” Emma Hall, (The Institute of Cancer Research, London, UK) said “We don’t yet have sufficient evidence to recommend preventative chemotherapy after surgical treatment for upper tract urothelial cancer. But this interesting observational data confirms the need for a randomised control trial. We’re in the process of recruiting patients for the Cancer Research UK-funded POUT trial to help answer this question.”
Zephyr/Science Photo Library
Adjuvant chemotherapy for upper tract urothelial cancer
Lancet Oncol 2017 Published Online January 12, 2017 http://dx.doi.org/10.1016/ S1470-2045(17)30020-7 For the study by Seisen and colleagues see J Clin Oncol 2017; published online Jan 3. DOI:10.1200/JCO.2016.69.4141
Sanjay Tanday
www.thelancet.com/oncology Published online January 12, 2017 http://dx.doi.org/10.1016/S1470-2045(17)30020-7
1
Use of adjuvant chemotherapy could boost overall survival for patients with locally advanced or positive regional lymph node urothelial carcinomas, new research suggests. Treatment options for this group of patients are limited, with radical nephroureterectomy the current standard of care for most patients. For this study, Thomas Seisen and colleagues (Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA) did an observational study using data from the National Cancer Database to compare the effectiveness of adjuvant chemotherapy versus observation in 3253 patients with node-positive upper tract urothelial carcinoma. 762 patients received adjuvant chemotherapy within 90 days of radical nephroureterectomy for upper tract urothelial carcinoma that was locally advanced stage pT3/T4, node positive,
or both, whereas the remaining 2491 patients were observed after radical nephroureterectomy. Patients who received adjuvant chemotherapy had longer overall survival than those who underwent observation. Median overall survival was 47·41 months (IQR 19·88–112·39) in the chemotherapy group and 35·78 months (IQR 14·09–99·22) in the observation group (p=0·001). Using inverse probability at treatment weighting analysis, the researches estimated 5 year overall survival to be 43·90% for the chemotherapy group and 35·85% for the observation group. Sumanta Kumar Pal (City of Hope Comprehensive Cancer Center, Duarte, CA, United States) said “Traditionally this is a population group that responds quite poorly to chemotherapy. Previous studies on the use of chemotherapy for this group of patients have been hampered by problems such as
selection bias. The findings of this study are compelling but they are no substitute for randomised trials. It is appropriate for clinicians to discuss chemotherapy with patients with upper tract urothelial carcinoma but my hope is that immunotherapy will improve survival for these patients. There are a number of trials already under way that are looking into this.” Emma Hall, (The Institute of Cancer Research, London, UK) said “We don’t yet have sufficient evidence to recommend preventative chemotherapy after surgical treatment for upper tract urothelial cancer. But this interesting observational data confirms the need for a randomised control trial. We’re in the process of recruiting patients for the Cancer Research UK-funded POUT trial to help answer this question.”
Zephyr/Science Photo Library
Adjuvant chemotherapy for upper tract urothelial cancer
Lancet Oncol 2017 Published Online January 12, 2017 http://dx.doi.org/10.1016/ S1470-2045(17)30020-7 For the study by Seisen and colleagues see J Clin Oncol 2017; published online Jan 3. DOI:10.1200/JCO.2016.69.4141
Sanjay Tanday
www.thelancet.com/oncology Published online January 12, 2017 http://dx.doi.org/10.1016/S1470-2045(17)30020-7
1