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First-line urothelial carcinoma analysis offers new insight into treatment selection and outcomes

bladder cancer

A real-world assessment of treatment patterns and clinical outcomes in patients with metastatic urothelial carcinoma found that more than 50% of patients had not received first-line systemic treatment. Among those who did, unadjusted real-world overall survival (OS) was longer in patients receiving frontline cisplatin versus other upfront options.1

“Real-world data related to treatment patterns and OS in patients with [metastatic urothelial carcinoma] are limited since [immune-oncology therapy] introduction, and this descriptive study fills that gap,” the investigators wrote in their poster, which was shared during the 2021 European Society for Medical Oncology Annual Congress.

The investigators used deidentified Centers for Medicare & Medicaid Services data from fee-for-service Parts A, B, and D claims. Patients 18 years or older with 1 or more inpatient or 2 or more outpatient visits with ICD-9/10 code for urothelial carcinoma were identified between January 1, 2015, and June 30, 2019. Patients had to have continuous enrollment for 6 months or longer pre-diagnosis index date and were followed from first-line treatment through the end of the study period, disenrollment, or death. Patient cohorts were divided into types of first-line treatment as follows: cisplatin, carboplatin-containing chemotherapy, immuno-oncology monotherapy, and non–platinum-containing chemotherapy.

A total of 18,888 patients met the study’s selection criteria, of whom 8630 (45.7%) had an identified first-line systemic treatment, and 10,258 had no identified first-line treatment. In the cohort who received first-line treatment, 37.6% received cisplatin, 30.2% received carboplatin-containing chemotherapy, 20.0% received immuno-oncology monotherapy, and 12.2% received non–platinum-containing chemotherapy. The majority of the patients who received first-line treatment were men (70%) and White (90%).

Patients who received cisplatin had a median Charlson Comorbidity Index Score of 3; all other treatment cohorts had a score of 4. Renal disease was present in 33.8% of patients who received immuno-oncology monotherapy, 28.3% of those receiving carboplatin, 26.0% of those receiving non–platinum-containing chemotherapy, and 11.9% of those receiving cisplatin.

Median survival was 20 months for patients receiving cisplatin, 14 months for those receiving non–platinum-containing chemotherapy, 11 months for those receiving carboplatin, and 8 months for those receiving immuno-oncology monotherapy.

Limitations outlined in the study’s poster include potential limited generalizability of the data due to being from a Medicare fee-for-service population; potential for miscoding of clinical conditions; the fact that algorithms were used to identify lines of therapy based on administrative claims; the fact that it was a descriptive study; and that no information was available regarding possible reasons why patients did not receive first-line treatment.

“Future research should assess outcomes with the newer standard of care and evaluate unmet needs in untreated populations,” the investigators concluded.


1. Bilen MA, Xi AD, Wong A, et al. Real-world (RW) treatment (Tx) patterns and clinical outcomes in patients (pts) with metastatic urothelial carcinoma (mUC) receiving first-line (1L) Tx: Results from IMPACT UC. Paper presented during the 2021 European Society for Medical Oncology Annual Congress; September 16-21, 2021; virtual. Abstract 701P.

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