Adjuvant Chemotherapy and Immunotherapy in Upper Tract Urothelial Carcinoma: Where Do We Stand?

Upper tract urothelial carcinoma (UTUC) is a rare malignancy that accounts for a small minority of all urothelial cancers. Historically, treatment recommendations for UTUC have been extrapolated from bladder cancer trials due to limited high-quality, UTUC-specific evidence. However, emerging data has shown how UTUC exhibits distinct biological, molecular, and clinical features compared to bladder cancer. In this piece, we provide an analysis of the current evidence supporting adjuvant chemotherapy and immunotherapy for UTUC. We discuss landmark trials such as the POUT trial for adjuvant chemotherapy, as well as pivotal trials such as CheckMate 274, IMvigor 010 and AMBASSADOR that examine the role of adjuvant immunotherapy for UTUC. Additionally, we briefly highlight advances in cancer genetics and the emerging use of circulating tumor DNA as a potential biomarker. While there has been significant progress made in adjuvant treatments for UTUC, substantial knowledge gaps remain. Clinical trials using UTUC-specific populations will be critical in improving outcomes and personalizing care for this patient population.