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Upper Tract Urothelial Cancer — SCE Medical Oncology MCQ

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ModerateUrological CancersUpper Tract Urothelial CancerSCE Medical Oncology

A 62-year-old man with upper tract urothelial carcinoma (UTUC) of the renal pelvis undergoes radical nephroureterectomy. Pathology shows pT3 high-grade urothelial carcinoma with lymphovascular invasion. What adjuvant chemotherapy is standard?

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Correct answer: A — No adjuvant chemotherapy is standard for UTUC

Historically, there was no standard adjuvant chemotherapy for UTUC. However, the POUT trial (Birtle et al Lancet 2020) demonstrated that adjuvant platinum-based chemotherapy improved DFS in high-risk resected UTUC. This has changed practice — gemcitabine-cisplatin (or gemcitabine-carboplatin if cisplatin-ineligible) for 4 cycles is now recommended for high-risk (pT2-T4 and/or N+) UTUC. Nivolumab adjuvant (CheckMate 274) is an alternative after platinum.

Reference: ESMO 2024 UTUC Guidelines; POUT trial Birtle et al Lancet 2020; CheckMate 274