(UroToday.com) The 2024 American Society of Clinical Oncology (ASCO) annual meeting featured a session on bladder cancer, and a presentation by Dr. Shilpa Gupta discussing age and other criteria influencing non-treatment of patients with locally advanced or metastatic urothelial carcinoma. Bladder cancer is the 10th most common cancer globally, with locally advanced or metastatic urothelial carcinoma being the most advanced stages. Although the standard of care for first-line treatment of locally advanced or metastatic urothelial carcinoma is changing rapidly with the emergence of new therapies, guidelines recommend that eligible patients should receive some form of systemic therapy.
However, real-world studies have shown that a majority of patients with locally advanced or metastatic urothelial carcinoma do not receive first-line systemic therapy, despite guideline recommendations. A systematic review of real-world data found that non-treatment was associated with several patient characteristics, including advanced age and female sex.1 A better understanding is needed about the criteria that physicians consider in real-world clinical practice when deciding whether to administer systemic treatment in patients with locally advanced or metastatic urothelial carcinoma. This cross-sectional study assessed the criteria that Eu5 physicians consider when making decisions about first-line therapy for patients with locally advanced or metastatic urothelial carcinoma.
A quantitative online survey of physicians in France, Germany, Italy, Spain, and the UK (Eu5) was performed in August - September 2022. To be eligible for the study, physicians were required to have specialized in oncology or urology, practiced medicine for >= 3 years, spent >= 50% of their time per week providing direct patient care, and treated >=2 patients with locally advanced or metastatic urothelial carcinoma per month. Respondents answered questions related to demographics, practice patterns, and criteria considered in first-line decision-making. Descriptive statistics were used to analyze demographics and responses. Logistic regression was used to analyze physician characteristics associated with reporting no age threshold versus any age threshold when defining platinum ineligibility.
There were 503 physicians (69% oncologists and 31% urologists) that completed the quota-based survey. Most respondents had been in practice for >10 years (69%) and treated 5-19 patients with locally advanced or metastatic urothelial carcinoma per month (58%) in public teaching hospitals (40%), public nonteaching hospitals (24%), and private hospitals (20%):
Physicians estimated that they do not prescribe first-line therapy for approximately 25% of their patients:
The majority of physicians selected advanced age (62.0%) and poor performance status (54.7%) as their top reasons for not prescribing first-line therapy, followed by patient refusal (45.9%) and poor renal function (43.1%):
Most physicians (78.1%) reported having an age threshold above which they recommend against first-line systemic therapy (mean, 74.7 years old). Across the 5 countries, physicians in France reported the lowest age threshold (66.6 years) while physicians in the UK reported the highest threshold (78.7 years):
After adjusting for baseline characteristics, physicians were more likely to have an age threshold if they were from Italy vs Germany (OR 3.00, 95% CI 1.26-7.45) and if they treated <20 patients/month (2-10 patients: OR 3.10, 95% CI, 1.74-5.69; 11-19 patients: OR 3.00, 95% CI 1.53-5.97) vs >= 20 patients:
Dr. Gupta concluded her presentation discussing age and other criteria influencing non-treatment of patients with locally advanced or metastatic urothelial carcinoma with the following take-home messages:
- First-line systemic therapy rates self-reported by Eu5 physicians were higher than those previously published
- Advanced age, poor performance status, patient refusal, and poor renal function were the most commonly reported factors influencing decisions on whether to treat a patient with first-line systemic treatment
- Many physicians reported having an age threshold for not offering systemic therapy, which was relatively low compared with the senior age profile of the locally advanced or metastatic urothelial carcinoma population
- Physicians who reported an explicit age threshold may be inappropriately excluding patients from therapy, which could be a driver for systemic therapy underutilization in locally advanced or metastatic urothelial carcinoma
Presented by: Shilpa Gupta, MD, Director, Genitourinary Medical Oncology, Taussig Cancer Institute, Co-Leader of the Genitourinary Oncology Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting, Chicago, IL, Fri, May 31 – Tues, June 4, 2024.
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