No First-line Therapy in Most Patients With Advanced Bladder Cancer

Most patients with de novo unresectable locally advanced or metastatic urothelial carcinoma did not receive first-line systemic therapy, according to a recent study.

Nimira Alimohamed, MD, FRCPC, of the Tom Baker Cancer Centre at the University of Calgary, and colleagues conducted the study because “despite a high disease burden, real-world data on treatment patterns in patients with unresectable locally advanced or metastatic urothelial carcinoma in Canada are limited.”

The retrospective, longitudinal cohort study evaluated treatment patterns and survival in 206 patients with unresectable locally advanced or metastatic urothelial carcinoma. Most patients (80.6%) had metastatic urothelial carcinoma, while 46.6% had 1 site of metastatic disease. The mean patient age was 73 years, with 78.2% of patients aged at least 60 years. All patients were from Alberta, Canada, and were diagnosed between the beginning of 2015 and the end of 2019. The study’s investigators followed patients until mid-2020.

Most patients (65%) did not receive any systemic therapies. The median first-line treatment duration was 2.8 months in the 35% of patients who did receive systemic therapies. Nearly half (48.6%) of patients who received first-line therapy received second-line therapy, with a median treatment duration of 3 months.

The median overall survival (OS) time from diagnosis was 5.3 months (95% CI, 4.5-7.0) in all patients, while the median OS from the start of first-line therapy was 9.1 months (95% CI, 6.4-11.6) in patients who received it, and the median OS from the start of second-line therapy was 4.6 months (95% CI, 3.9-19.2) in patients who received it.

More than half of the patients (58.7%) received a referral to a medical oncologist, while the remaining patients did not receive a referral. Patients who were referred to a medical oncologist had a longer median OS (8.6 months; 95% CI, 7.1-11.9) than patients who were not referred, who had a median OS of 3 months (95% CI, 2.2-4.1).

While “these results present a snapshot in time of the [unresectable locally advanced or metastatic urothelial carcinoma] population, including treatment patterns prior to the reimbursement, and widespread use, of novel therapies such as pembrolizumab, avelumab, enfortumab vedotin, and erdafitinib,” they showed the “importance of referral to a medical oncologist and the ongoing need for effective therapies in these patients,” Dr. Alimohamed and colleagues wrote.

“The majority of patients did not receive first-line systemic therapy, and, in those who did, survival outcomes were poor,” Dr. Alimohamed and colleagues concluded. “This study highlights the significant unmet need for safe and efficacious therapies for patients with [unresectable locally advanced or metastatic urothelial carcinoma] in Canada.”

Reference

Understanding treatment patterns and outcomes among patients with de novo unresectable locally advanced or metastatic urothelial cancer: a population-level retrospective analysis from Alberta, Canada.