Multicenter phase 2 trial of neoadjuvant durvalumab plus chemotherapy for operable high-risk upper tract urothelial carcinoma

After radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC), prognosis is poor for high-risk patients. The multicenter phase 2 iNDUCT trial in France evaluated neoadjuvant durvalumab plus gemcitabine-cisplatin (cohort 1) or durvalumab plus gemcitabine-carboplatin (cohort 2) for these patients. At surgery, rates of pT0 were 13% in cohort 1 and 5% in cohort 2; whiel 52% in cohort 1 and 42% in cohort 2 were pTa/pT1. The safety profile was good, and the surgical risk was not increased. The authors conclude that while the study did not meet the primary endpoint of pathological complete response, the combination of durvalumab and chemotherapy showed promising results in terms of downstaging (video summary).