Would you offer adjuvant chemotherapy for platinum eligible patients with pT2pN0 urothelial carcinoma of bladder or UTUC who did not receive neoadjuvant chemotherapy?

I agree with both of my colleagues that adjuvant cisplatin-based combination chemotherapy is unproven for pT2N0 bladder cancer, although the POUT upper tract urothelial carcinoma phase III trial (which demonstrated significantly improved DFS) did recruit >=pT2N0 patients to evaluate adjuvant gemcitabine-platinum. However, off-protocol, I have considered adjuvant cisplatin-based chemotherapy in selected high-risk cisplatin-eligible pT2N0 bladder cancer patients. In a previously published paper, w...

In my practice, I'd offer both, but I'd recommend trial if it is available

If there is no trial:

I would say "yes" for upper tract urothelial carcinoma (UTUC). I routinely discuss and recommend adjuvant therapy based on the POUT study It showed the benefit of adjuvant therapy with platinum and gemcitabine in pT2-T4 pN0-3 disease of UTUC. Of note, pN0 of 90% in both arms and pT2 of 23% and 34% respectively in surveillance and intervention arm. Platinum could be cis or carbo. ~65% with CrCl > 50 ml...

In the setting of urothelial carcinoma of the upper tract including the renal pelvis and/or ureter, the POUT trial (The Lancet 2020), a phase 3 randomized controlled trial evaluating adjuvant chemotherapy with 4 cycles of either gemcitabine with cisplatin or carboplatin as compared to surveillance in patients with upper tract urothelial carcinoma (UTUC) after nephroureterectomy (pT2-4 pN0-N3 M0 or pTany N1-3 M0) demonstrated an improvement in DFS. Adjuvant chemotherapy significantly improved DFS...