Criteria used to determine platinum eligibility and first-line (1L) treatment (tx) patterns among platinum-eligible (PE) and -ineligible (PI) patients (pts) with metastatic urothelial cancer (mUC) in France, Germany, Spain, Italy, and the United Kingdom (Eu5).

Abstract

457 Background: European Society for Medical Oncology (ESMO) guidelines recommend tx for mUC based on cisplatin and platinum eligibility. To date, most real-world analyses have not included physician-confirmed eligibility status. This study collected mUC patient data in Eu5 and summarized the criteria used in the real-world setting to determine PE and 1L tx prescribed based on PE. Methods: Data were drawn from the Adelphi mUC Disease-Specific Programme, a real-world point-in-time study conducted from November 2020 to April 2021. Oncologists and urologists were enrolled in the study and recruited the next 8 eligible pts who came for a consultation. Demographic, clinical characteristics, platinum eligibility, and tx patterns were collected. Results: Physicians provided data on 1,868 mUC pts who were receiving or had completed 1L tx and had a known PE status as determined by a physician prior to 1L tx. Renal function contributed to physicians’ platinum eligibility decisions for 72% of pts; ECOG score and age were used in 59% and 38% of pts, respectively. The mean (SD) age was 69.1 (7.88) years and 73% were men. At initial mUC diagnosis (dx), 25% were PD-L1–positive, 17% were PD-L1–negative, and 58% had either unknown PD-L1 status or were not tested. 87% of pts were PE (55% were eligible for cisplatin and carboplatin; 31% were cisplatin ineligible), and 13% were PI. PE pts who were eligible for cisplatin and carboplatin were younger than cisplatin ineligible and PI pts (66.6, 71.9 and 73.1 years, respectively). The percentage of pts with ECOG 0 or 1 at dx was 92%, 79%, and 67% for cisplatin and carboplatin eligible, cisplatin ineligible, and PI pts respectively. Conclusions: Only a small proportion of pts were classified as PI. The majority of PE pts received guideline-recommended tx with platinum-based regimens in the 1L. Overall, there was limited use of immune checkpoint inhibitor tx in the 1L, with use observed primarily among PI pts. Some guideline deviations were observed, including pts deemed PI who still received platinum-based chemotherapy. Recently, ESMO guidelines were updated to include avelumab for 1L maintenance tx in PE pts. Future studies should evaluate concordance with updated guideline recommendations in PE pts and rationale for guideline deviations.[Table: see text]