Adjuvant treatment preferences in high-risk upper tract urothelial carcinoma: the perspective of Portuguese medical oncologists

Although upper tract urothelial carcinoma (UTUC) and bladder urothelial carcinoma (BUC) share histological features, they differ in clinical behavior and management. Valid adjuvant options include surveillance, platinum-based chemotherapy, and immune checkpoint inhibitors (ICIs). To assess real-world practice, we conducted a survey among Portuguese medical oncologists dedicated to genitourinary malignancies, exploring their preferences for adjuvant therapy in high-risk UTUC (illustrated as pT2N1M0) across three clinical scenarios that differed by PD-L1 status and renal function. Among 34 respondents, cisplatin plus gemcitabine was the preferred regimen in cisplatin-eligible patients, regardless of PD-L1 status (94% in PD-L1-negative and 85% in PD-L1-positive tumors). In PD-L1-positive, cisplatin-ineligible patients, carboplatin plus gemcitabine was preferred (47%), followed by ICIs (44%). These findings suggest a consistent preference for platinum-based chemotherapy, likely reflecting UTUC-specific evidence from the POUT trial and apparent limited ICI benefit in this subgroup, underscoring the need for dedicated prospective trials.