(UroToday.com) In the on-demand poster session of the European Society for Medical Oncology (ESMO) Annual Congress, Dr. Morgans presented an observational study characterizing treatment patterns and subsequent second-line therapy in both cisplatin-eligible and ineligible patients with aUC. In the past few years, programmed death 1/ligand 1 inhibitors (PD-1/L1i) have become recommended for first-line (1L) therapy in aUC patients who are cisplatin-ineligible and have high PD-L1 expression or who are ineligible for any platinum-containing chemotherapy regardless of PD-L1 status. However, current, real-world data on PD-1/L1i use in this setting are limited.
The authors included patients aged ≥18 years who were diagnosed with aUC (Stage IV UC) from May 2016–July 2020 based on the nationwide Flatiron Health de-identified electronic health record-derived database. The authors further required activity in the database in the 90 days post-aUC diagnosis date (index). The cohort received first-line therapy on/after index, with follow-up through October 2020. The authors described patient characteristics and first- and second-line treatment patterns in the population overall and by cisplatin eligibility (defined per Galsky criteria).
The authors examined a total of 4,063 patients of whom 3,119 (76.8%) received first-line therapy, with median follow-up of 8.5 (IQR 3.9-17.1) months. The mean age of patients at the time of aUC diagnosis was 72.2 years and 72.6% were male. Among the 3119 patients who received first-line therapy, 1,229 (39.4%) received a 1L PD-1/-L1i. Approximately half of patients receiving first-line therapy were cisplatin-ineligible (50.9%). A higher proportion of cisplatin-ineligible (50.1%) than cisplatin-eligible (28.3%) patients were treated with PD-1/-L1i in the first-line setting. Only 42.5% of treated patients received any second-line therapy, with differences based on the type of first-line therapy received: 24.6% following 1L PD-1/L1i vs 54.5% following first-line chemotherapy.
The authors conclude that, in real-world practice, approximately three-quarters of patients with mUC received systemic treatment, with PD-1/-L1i accounting for approximately 40% of first-line regimens. Following 1L PD-1/L1i, a lower proportion of patients received second-line therapy relative to those treated with first-line chemotherapy. Thus, there remains a significant unmet need for safe and efficacious therapies for patients with aUC following first-line PD-1/L1i therapy.
Presented by: Alicia Morgans, MD, MPH Genitourinary Medical Oncologist, Medical Director of Survivorship Program at Dana-Farber Cancer Institute, Boston, Massachusetts.