1763P Real-world outcomes before and after the access to immune-checkpoint inhibitors (ICI) in advanced urothelial carcinoma (aUC)

Abstract

We compare treatment patterns and survival of patients (pts) with aUC treated before and after the access to ICI in a tertiary hospital at Barcelona, Spain. We analyze medical records from pts with aUC between June 2004 and June 2021. Access to ICI began in December 2014. Baseline characteristics (surgery history, site of tumor, [neo]adjuvant therapy, metastatic debut, site of metastasis), treatments (first-line [1L], second-line [2L] and third-line [3L]), and survival data were collected. A descriptive analysis was made to compare the pre and post ICI periods. Kaplan-Meier methods were used to evaluate overall survival (OS) and progression-free survival (PFS). We included 245 pts, 72% were ≥65 years. Nine percent were referred to the palliative unit, and 7% were only followed-up after surgery. Of the 206 pts who started 1L, 90 (44%) did so in the pre-ICI period, and 116 (56%) in post-ICI. Median follow-up time was 48.6 months (IQR: 21.2-131.7). No baseline clinical differences between periods were found. During pre-ICI, 51%, 37% and 12% of pts received 1L with carboplatin (CB), cisplatin (CIS) and non-platinum (NP) based chemotherapy, respectively. Regarding 2L, 39%, 32% and 27% received NP, CIS and CB. For 3L, 76% of pts received NP and 20% CB. During post-ICI, 48%, 28% and 18% of pts received 1L with CB, CIS and ICI, respectively. For 2L, 58%, 16% and 11% received ICI, CB and CIS, respectively. Finally, 35% and 31% of pts received a targeted therapy and NP as 3L, respectively. Fifty-eight out of 116 (50%) pts received ICI. We found no differences in the number of pts requiring 2L or 3L, mOS or mPFS between periods (Table). Thirty-two (36%) and 27 (23%) pts treated in pre and post ICI had an OS ≥ 2 years (p=0.075), respectively.Table: 1763PTreatment*Pre-ICI (N=90)Post-ICI (N=116)Overall (N=206)1L, n (%)90 (100)116 (100)206 (100)mOS**14.4 (9.9-22.2)17.7 (14.5-25.8)17.1 (13.7-21.7)mPFS**7.3 (6.0-10.1)7.3 (6.4-9.6)7.3 (6.6 -9.1)2L, n (%)41 (46)57 (49)98 (48)mOS**11.3 (8.5-15.5)8.2 (7.4-11.7)9.8 (7.8-12.6)mPFS**5.3 (3.4-6.0)3.6 (2.5-5.6)4.4 (3.2-5.4)3L, n (%)25 (28)29 (25)54 (26)mOS**7.5 (5.7-11.9)3.7 (2.7-8.0)6.8 (3.6-8.3)mPFS**5.7 (3.6-8.5)2.9 (2.3-7.1)3.9 (2.7-6.8)*p-value was not significant for all comparisons. **months (95% CI) Open table in a new tab *p-value was not significant for all comparisons. **months (95% CI) Access to ICI did not impact on mOS, mPFS or subsequent therapies. No differences in 2-year OS were found. A reduction in the use of CIS and NP was recognized.