MP48-05 NEOADJUVANT CHEMOTHERAPY IN ELDERLY PATIENTS WITH UPPER TRACT UROTHELIAL CANCER: ONCOLOGIC OUTCOMES FROM A MULTICENTER STUDY

Abstract

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II (MP48)1 Sep 2021MP48-05 NEOADJUVANT CHEMOTHERAPY IN ELDERLY PATIENTS WITH UPPER TRACT UROTHELIAL CANCER: ONCOLOGIC OUTCOMES FROM A MULTICENTER STUDY Nico C. Grossmann, Benjamin Pradere, David D'Andrea, Victor M. Schuettfort, Keiichiro Mori, Pawel Rajwa, Fahad Quhal, Ekaterina Laukhtina, Satoshi Katayama, Christian D. Fankhauser, Evanguelos Xylinas, Vitaly Margulis, Alberto Briganti, Pierre I. Karakiewicz, and Shahrokh F. Shariat Nico C. GrossmannNico C. Grossmann More articles by this author , Benjamin PradereBenjamin Pradere More articles by this author , David D'AndreaDavid D'Andrea More articles by this author , Victor M. SchuettfortVictor M. Schuettfort More articles by this author , Keiichiro MoriKeiichiro Mori More articles by this author , Pawel RajwaPawel Rajwa More articles by this author , Fahad QuhalFahad Quhal More articles by this author , Ekaterina LaukhtinaEkaterina Laukhtina More articles by this author , Satoshi KatayamaSatoshi Katayama More articles by this author , Christian D. FankhauserChristian D. Fankhauser More articles by this author , Evanguelos XylinasEvanguelos Xylinas More articles by this author , Vitaly MargulisVitaly Margulis More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author , and Shahrokh F. ShariatShahrokh F. Shariat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002074.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The highest incidence of upper tract urothelial carcinoma (UTUC) is between 70-90 years of age and neoadjuvant chemotherapy (NAC) before radical nephroureterectomy (RNU) has shown promising oncologic outcomes. Nevertheless, the outcomes in elderly patients have never been explored despite the high incidence of elderly in UTUC. The objective was to assess the impact of NAC on pathological response and its association with survival outcomes in elderly patients. METHODS: This multicenter, retrospective study included patients who were treated with NAC and RNU for clinically non-metastatic UTUC. The cohort was stratified into two groups according to median age. Patients received either platinum-based or non-platinum-based chemotherapies. The primary endpoint was pathologic responses defined as pathologic downstaging (<ypT1N0) and pathologic complete response (ypT0N0). Univariable and multivariable logistic and Cox regression analyses were performed to identify associations between age groups, treatment regimens, chemotherapy cycles and pathological response as well as survival outcomes. RESULTS: Among the overall cohort we included 170 patients who met inclusion criteria. The median age of the cohort was 68 years (IQR 62-73) and the elderly group (>68 years) included 77 patients. The median follow-up was 29 months (IQR 11-64). Sixty-eight patients (41%) received MVAC, 66 (40%) GC and 32 (19%) non-platinum chemotherapy. Pathological downstaging (pDS) and complete pathologic response (pCR) were similar between groups (51% vs. 48%; p=0.7 and 9.7% vs. 9.1%; p=0.9, in younger and elderly groups respectively). On multivariable analysis, MVAC was independently associated with pCR on multivariable analysis (OR 4.41, 95% CI: 1.19-19.3; p=0.04) and showed a higher rate of pCR (14%) compared to other regimens (p=0.037). Non-platinum chemotherapy revealed a low pCR rate of 3.1%. There were no differences is Kaplan-Meier analysis in recurrence-free survival (RFS) and cancer-specific survival (CSS) between groups. CONCLUSIONS: Elderly patients with high-risk UTUC eligible to NAC prior to RNU may benefit from this multimodal therapy as well as their younger counterparts. Despite the reluctance to provide systemic therapy in elderly patients, this option appears to be efficient and further studies are required to define the best candidates. Nevertheless, since mainly only elderly patients fit for platinum-based chemotherapy experienced pathologic response, ineligible patients may be proposed alternative therapeutic options. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e865-e865 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nico C. Grossmann More articles by this author Benjamin Pradere More articles by this author David D'Andrea More articles by this author Victor M. Schuettfort More articles by this author Keiichiro Mori More articles by this author Pawel Rajwa More articles by this author Fahad Quhal More articles by this author Ekaterina Laukhtina More articles by this author Satoshi Katayama More articles by this author Christian D. Fankhauser More articles by this author Evanguelos Xylinas More articles by this author Vitaly Margulis More articles by this author Alberto Briganti More articles by this author Pierre I. Karakiewicz More articles by this author Shahrokh F. 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