Multicenter phase 3 trial of adjuvant chemotherapy after nephroureterectomy for upper tract urothelial cancer: final results of POUT

The phase 3 POUT trial, at 57 centers in the UK, included 261 patients after nephroureterectomy for muscle-invasive or lymph node-positive, nonmetastatic upper tract urothelial cancer (UTUC). Patients were randomized to adjuvant chemotherapy (gemcitabine-cisplatin or gemcitabine-carboplatin; n=132) or surveillance (n=129). Final analysis of the trial has now been published, with mediane follow-up of 65 months (IQR 60-84). Compared with surveillance, adjuvant chemotherapy improved disease-free survival, metastasis-free survival, disease-specific survival, and overall survival. These results were consistent across chemotherapy regimes and disease stage. There were no unexpected toxicities, and there were no clinically relevant differences in quality of life between the two groups. The authors conclude that these updated results add further support for the use of adjuvant chemotherapy in patients with UTUC.