(UroToday.com) At the 2022 American Society of Clinical Oncology Annual Meeting held in Chicago and virtually, the poster session focused on Kidney and Bladder cancers on Saturday afternoon included a presentation from Dr. Frank Liu discussing practice patients and decision making considerations in locally advanced or metastatic urothelial carcinoma (la/mUC) among practicing US-based oncologists.
While cisplatin-based chemotherapy remains the preferred treatment approach for patients with locally advanced or metastatic UC who are eligible, there have been substantial changes in the treatment landscape in the past few years with the introduction of immune checkpoint inhibitors as second-line therapy in patients with platinum-refractory disease, as first-line maintenance therapy, and as first-line treatment among some cisplatin-ineligible patients. Thus, the authors performed a cross-sectional survey to explore practice patterns in this disease space and clinical decision-making.
The authors utilized an online survey which was completed by 150 community/academic US oncologists between September and Oct 2021. The respondents provided information on demographics, use of first-line treatment, use of first-line maintenance therapy, attributes in terms of treatment selection in both first-line and first-line maintenance, and factors associated with each of these treatment approaches.
Physicians were dichotomized into 4 pre-specified groups using the median percentage (%) as a cutoff: 1) more frequent first-line prescriber 2) less frequent first-line prescriber, defined based on the proportion of patients treated with first line therapy in the past 6 months; 3) more frequent first-line maintenance prescriber; and 4) less frequent first-line maintenance prescriber, defined based on the proportion of patients eligible for first-line maintenance therapy who received it.
Descriptive and bivariate analyses were used to assess attributes (scored out of 100 points across 16 attributes) associated with first-line treatment selection and first-line maintenance use. Multivariable logistic regression was used to assess factors associated with more/less frequent first-line treatment selection and first-line maintenance use.
Among the 150 respondents, the median time in practice was 15 years (range, 2-31). The majority (63%) were in community practice compared with 37% in academic settings. The median % of locally advanced or metastatic UC patients who received first-line treatment was 46% (range, 25-89%). 72 physicians were categorized as more frequent first-line therapy prescribers, while 78 were less frequent first-line therapy prescribers.
Attributes used in first-line treatment selection differed among more vs less frequent first-line treatment prescribers: mean scores for efficacy/overall survival (OS), disease control rate (DCR), or rate of grade 3/4 adverse events (AEs) were 23 vs 17, 10 vs 8, and 10 vs 5, respectively (all p < 0.05). Oncologists who stated OS, DCR, or rate of grade 3/4 AEs as important factors impacting treatment selection were more likely to prescribe first-line treatment (all p < 0.05).
The median proportion of eligible patients who received first-line maintenance was 71% (range, 0-100%). 71 physicians were categorized as more frequent first-line maintenance prescribers, while 75 were less frequent first-line maintenance prescribers. Similar to findings in first-line treatment selection, for more vs less frequent first-line maintenance prescribers, mean scores for efficacy/OS, rate of grade 3/4 immune-mediated AEs, and inclusion in institutional guidelines/pathways were 23 vs 16, 6 vs 4, and 2 vs 4. Regarding first-line maintenance use, oncologists based in the academic setting, those who reported using RECIST 1.1 criteria to assess treatment response or agreed first-line maintenance is important to prolong OS were all more likely to prescribe first-line maintenance (all p < 0.05). Those who reported that their institutional guidelines/pathways impact treatment decisions or cited prior IO use before metastatic diagnosis as reason not to prescribe first-line maintenance were less likely to prescribe first-line maintenance (all p < 0.05).
The authors conclude that there is considerable variability in physician attitudes towards first-line treatment and first-line maintenance therapy in metastatic UC, despite several physician characteristics being associated with this treatment patterns.
Presented by: Frank Liu, EMD Serono, Rockland, MA