Practice trends and attitudes of medical oncologists on new therapies in urothelial carcinoma.

Abstract

472 Background: Treatment options for patients with metastatic urothelial carcinoma (mUC) have dramatically changed. The goal of this study was to assess the worldwide impact and use of new therapeutic developments in clinical practice. Methods: The study consisted of qualitative telephone interviews (3/25/19-4/5/19) and a quantitative online survey (3/20/19-5/27/19) with questions designed to determine current practice trends and specific challenges faced by clinicians. Participants were recruited via email and answers were compared with those of experts and guideline recommendations. Results: A total of 30 US-based clinicians completed the interviews and 491 participants (US, n = 156; ex-US, n = 335) completed the online survey. Most participants (69%) treated ≤ 10 patients with UC per month. For newly diagnosed mUC, many participants failed to select appropriate first-line therapy based on creatinine clearance (CrCl) and PD-L1 expression (Table). Only 58% of clinicians correctly selected SoC cisplatin-based chemotherapy for eligible patients based on CrCl. For cisplatin-ineligible patients, 60% of clinicians indicated use of an immune checkpoint inhibitor (ICI) despite low PD-L1 expression. Many clinicians were also unfamiliar with novel agents. Only 56% recognized the mechanism of action (MoA) of erdafitinib, an FGFR inhibitor approved during the survey period, and 31% recognized the MoA of enfortumab vedotin, an investigational agent with FDA breakthrough therapy designation. About 40% of US clinicians and < 20% of ex-US clinicians indicated confidence to use these agents in clinical practice if available. Conclusions: This study highlights the need for ongoing education on the optimal use of novel therapeutic strategies to care for patients with mUC. [Table: see text]