Gemcitabine and Cisplatin as Neoadjuvant Chemotherapy in Patients With High-Grade Upper Tract Urothelial Carcinoma

Inclusion Criteria: * Histologically confirmed high-grade upper tract transitional cell carcinoma at MSKCC or a participating site and/or radiographically visible tumor stage T2-T4a N0/X M0 disease with positive selective urinary cytology or high-grade concomitant bladder tumor. Hydronephrosis associated with tumor on biopsy will be considered invasive by definition. * Medically appropriate candidate for radical nephroureterectomy or ureterectomy as per MSKCC or a participating site attending urologic oncologist * Karnofsky Performance Status ≥ 70% * Age ≥ 18 years of age * Required Initial Laboratory Values: * Absolute neutrophil count ≥ 1500 cells/mm3 * Platelets ≥ 100,000 cells/mm3 * Hemoglobin ≥ 9.0g/dL * Bilirubin ≤ 1.2 * Aspartate transaminase (AST) and alanine transaminase (ALT) ≤ 2.5 x ULN for the institution * Alkaline phosphatase ≤ 2.5 x ULN for the institution * Serum creatinine ≤ 1.3 mg/dL if male or ≤ 1.1 mg/dL if female OR calculated creatinine clearance ≥ 55 ml/min/1.73m\^2 If female of childbearing potential, serum pregnancy test is negative. * Patients with reproductive potential must use an effective method to avoid pregnancy for the duration of the trial. ml/min/1.73m2 using the formula: CKD epi : GFR = 141 X min(Scr/κ,1)α X max(Scr/κ,1)-1.209 X 0.993Age X 1.018 \[if female\] X 1.159 \[if black\] * Scr is serum creatinine, k is 0.7 for females and 0.9 for males, a is -0.329 for females and -0.411 for males, min indicates the minimum of Scr…