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

## TL;DR

Portuguese medical oncologists prefer platinum-based chemotherapy for high-risk upper tract urothelial carcinoma, even when PD-L1 status varies.

## Contribution

This study reveals adjuvant treatment preferences of Portuguese oncologists for high-risk UTUC based on PD-L1 status and cisplatin eligibility.

## Key findings

- Cisplatin plus gemcitabine is the preferred regimen for cisplatin-eligible patients regardless of PD-L1 status.
- In cisplatin-ineligible PD-L1-positive patients, carboplatin plus gemcitabine is preferred over immune checkpoint inhibitors.
- Preferences reflect reliance on UTUC-specific evidence and limited perceived benefit from ICIs in this subgroup.

## Abstract

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.