At the recent 2026 ASCO Genitourinary Cancers Symposium (ASCO GU26), Dr Jeannie Hoffman-Censits (The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Center, Baltimore, MD, USA) presented data from ECOG-ACRIN EA8192 cohort C (Abstract 749), exploring a new approach for patients with high-grade (HG) upper tract urothelial carcinoma (UTUC) who are ineligible for cisplatin. With neoadjuvant options limited in this population, the trial assessed whether combining chemotherapy with immunotherapy could improve outcomes.
This phase II multicentre study enrolled 31 patients (median age 79), who received four cycles of gemcitabine plus durvalumab (GD) prior to planned radical nephroureterectomy. Using a Simon two-stage design, the primary endpoint was pathologic complete response (pCR), with ≥18% considered clinically meaningful. Secondary endpoints included safety, event-free survival (EFS), disease-free survival (DFS) and overall survival (OS).
Among the 30 treated patients, 3 achieved pCR (10%; 90% CI: 3.0–25.2%), and 10 patients (33%; 90% CI: 19.3–49.9%) achieved < ypT2N0/x, suggesting substantial tumour downstaging. All patients experienced treatment-related adverse events, though grade 3-4 toxicities occurred in 13 patients, most commonly anemia and neutropenia, and no grade 5 events were reported. Surgery proceeded with a median of 10 weeks from last GD dose, and 1-year EFS rate was promising.Â
The investigators concluded that neoadjuvant GD is feasible and generally well tolerated in cisplatin-ineligible HG UTUC, providing modest pCR rates and promising early survival signals. Ongoing follow-up will clarify longer-term outcomes, including DFS and OS, while biomarker studies are planned to refine patient selection.
Citation: ECOG ACRIN EA8192 cohort C: Neoadjuvant gemcitabine-durvalumab in cisplatin-ineligible UTUC. touchONCOLOGY. 24th March 2026.
Disclosure: Petros Grivas discloses consulting with MSD, Bristol Myers Squibb, AstraZeneca, EMD Serono, Pfizer, Janssen, Roche, Astellas Pharma, Gilead Sciences, Strata Oncology AbbVie, Bicycle Therapeutics, Replimune, Daiichi Sankyo, Foundation Medicine, Eli Lilly, Urogen and Tyra Biosciences. He has received research funding from Bristol-Myers Squibb, MSD, EMD Serono, Gilead Sciences, Acrivon Therapeutics, ALX Oncology and Genentech (paid to the institution). This article was created by the touchONCOLOGY team utilizing AI as an editorial tool (ChatGPT (GPT-4o) [Large language model]. https://chat.openai.com/chat.) The content was developed and edited by human editors. No funding was received in the publication of this article.
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