Evolving treatment patterns and outcomes among patients with metastatic urothelial carcinoma post-avelumab maintenance approval: insights from The US Oncology Network

Abstract

Background

The addition of immune checkpoint inhibitors (ICIs) and antibody–drug conjugates into the metastatic urothelial cancer (mUC) treatment landscape has advanced therapeutic strategies beyond platinum-based chemotherapy (PBT). We evaluated real-world treatment patterns and overall survival (OS) among mUC patients during the period between maintenance avelumab (maintA) and enfortumab vedotin plus pembrolizumab approvals in the United States.

Materials and methods

This retrospective cohort study utilized structured and chart review data from iKnowMed, a United States community oncology electronic health record database, to identify adult mUC patients initiating first-line (1L) anticancer treatment (index date) between April 2020 and September 2022. Patients were followed from the index date until March 2023, the last patient visit, or death, whichever occurred first. Descriptive statistics were used to report treatment patterns. Kaplan–Meier methods were used to assess OS.

Results

A total of 597 patients initiated 1L treatments (ICI monotherapy: 47.9%, PBT: 40.7%, other: 11.4%). The median age at diagnosis was 74 years, and 76.9% were male. Among patients receiving 1L PBT, 39.5% received maintA. Among those who were not on prior treatment at the end of the follow-up, 32.7% and 11.3% of 1L-treated patients received second-line and third-line treatment. The median OS from the index date for 1L-treated patients was 11.8 months (95% confidence interval 10.4-14.2 months).

Conclusions

Despite the approval of maintenance therapy, prognoses for mUC patients remained poor. ICI monotherapy continues to be a common option in 1L. Many 1L patients did not have an opportunity to receive subsequent treatment, highlighting the continuing unmet need for mUC patients.