Tests disitamab vedotin with tislelizumab before surgery in HER2-positive upper tract urothelial cancer

Trial details

Who runs it

RenJi Hospital

Trial code

NCT07584733

Record updated

13 May 2026

Original description

This is a prospective, multicentre, single-arm phase II study evaluating a response-adapted kidney-preserving strategy in patients with HER2-positive high-risk upper tract urothelial carcinoma (UTUC). Patients will receive neoadjuvant disitamab vedotin plus tislelizumab, followed by response-adapted local treatment, including kidney-sparing surgery or radical nephroureterectomy based on predefined criteria.Read full original descriptionShow less

A Prospective, Multicentre, Single-Arm Phase II Study Evaluating a Response-Adapted Kidney-Preserving Strategy Using Neoadjuvant Disitamab Vedotin Plus Tislelizumab in Patients With HER2-Positive High-Risk Upper Tract Urothelial Carcinoma (DISTINCT-II)

This is a prospective, multicentre, single-arm phase II study evaluating a response-adapted kidney-preserving strategy in patients with HER2-positive high-risk upper tract urothelial carcinoma (UTUC). Patients will receive neoadjuvant disitamab vedotin plus tislelizumab, followed by response-adapted local treatment, including kidney-sparing surgery or radical nephroureterectomy based on predefined criteria.

The primary objective is to assess whether this multimodal strategy can achieve clinically meaningful oncologic control while preserving renal function, as measured by 1-year kidney-intact event-free survival (KI-EFS). Secondary and exploratory objectives include evaluation of clinical response, survival outcomes, safety, renal function preservation, and longitudinal dynamics of circulating and urinary tumor DNA.

Inclusion: Age ≥18 years at the time of informed consent; Histologically confirmed upper tract urothelial carcinoma (UTUC) arising from the renal pelvis or ureter, based on ureteroscopic biopsy; High-risk UTUC, defined by at least one of the following features: Tumour size ≥2 cm; High-grade cytology or biopsy; Radiographic evidence of local invasion (≥cT2); Hydronephrosis; Multifocal disease; Clinical stage cT1-T3, N0-N1, M0, based on radiographic assessment; N1 disease is permitted only if lymph nodes are considered resectable; HER2-positive disease, defined as immunohistochemistry (IHC) score of 1+，2+ or 3+ on tumour tissue, assessed according to predefined criteria; At least one measurable lesion according to RECIST version 1.1; ECOG performance status of 0-1; Adequate organ function, including: Hematologic function; Hepatic function; Renal function (no strict upper/lower limit required); Patients must be considered potential candidates for a kidney-preserving treatment strategy, including: Absolute or relative indication for renal preservation (e.g., solitary kidney, baseline renal insufficiency), or Strong preference for kidney preservation after multidisciplinary discussion; Ability to understand and willingness to sign written informed consent.

Exclusion: Prior systemic therapy for urothelial carcinoma, including:Chemotherapy; Immunotherapy; HER2-targeted therapy; Prior radical nephroureterectomy for current disease; Current use of immunosuppressive medication, excluding physiologic doses of corticosteroids; Evidence of distant metastatic disease (M1); Unresectable or bulky nodal disease (≥N2) not amenable to curative-intent surgery; Active autoimmune disease requiring systemic treatment within the past 2 years; Uncontrolled intercurrent illness, including but not limited to: Active infection requiring systemic therapy; Uncontrolled cardiovascular disease; Significant pulmonary disease; Known active hepatitis B, hepatitis C, or HIV infection with uncontrolled viral replication; History of another malignancy within the past 5 years, except: Adequately treated basal cell carcinoma; Squamous cell skin cancer; In situ carcinoma; Any condition that, in the opinion of the investigator, would interfere with study participation or interpretation of results; Pregnant or breastfeeding women.

ClinicalTrials.gov NCT07584733