FIRST-LINE SYSTEMIC TREATMENT PATTERNS IN METASTATIC UROTHELIAL CARCINOMA IN US COMMUNITY ONCOLOGY PRACTICES
Author(s)
Dhaval Shah, MD, MBA1, Asit Paul, MD, PhD2, Deepak Kilari, MD3, Roby Thomas, MD4, Bogdana Schmidt, MD, MPH5, Alejandro Sanchez, MD5, Rushir Choksi, MD4, John Li, MPH, PhD6, Gino Cioffi, MPH, PhD6, Steven W. Champaloux, MPH, PhD6, Don Parris, MPH, PhD6, Anna Rui, MPH6, Mike Gart, MBA6, Brandon Wang, MBA6, Prateesh Varughese, PharmD, MBA6, Jeffrey Scott, MD6, Manish Kohli, MD5;
1Medical Oncology Hematology Consultants, Newark, DE, USA, 2Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, VA, USA, 3Medical College of Wisconsin, Milwaukee, WI, USA, 4University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 5University of Utah, Salt Lake City, UT, USA, 6PrecisionQ, IntegraConnect, West Palm Beach, FL, USA
1Medical Oncology Hematology Consultants, Newark, DE, USA, 2Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, VA, USA, 3Medical College of Wisconsin, Milwaukee, WI, USA, 4University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 5University of Utah, Salt Lake City, UT, USA, 6PrecisionQ, IntegraConnect, West Palm Beach, FL, USA
OBJECTIVES: The treatment landscape for metastatic urothelial carcinoma (mUC) in the first-line (1L) setting has evolved with the recent approval of enfortumab vedotin EV+ pembrolizumab (EV+P). However, the real-world word adoption of these therapies in U.S. community oncology practices is unknown. This work aimed to assess current utilization patterns of 1L treatment regimens for mUC in this setting.
METHODS: Using the Integra PrecisionQ database containing ~2.2 million deidentified medical records, adults with mUC initiating 1L systemic therapy between 01-Dec-2023 and 07-Jul-2025 were assessed. Regimens were grouped as EV+pembrolizumab (EV+P, EV monotherapy (mono)/other, chemotherapy (chemo), immunotherapy (IO), and IO+chemo. Patient characteristics included age (≤65 vs. 65+ years), sex, race, ethnicity, payer, Eastern Cooperative Oncology Group performance status, metastatic type (de novo vs. recurrent), region, NCI comorbidity index, and treatment year treatment regimens. Chi-squared tests were used to compare distributions across groups
RESULTS: A total of 742 patients initiated 1L therapy with EV+P (n=407), EV mono/other (n=14), chemo (n=124), IO (n=131), IO+chemo (n=54), or other (n=12). Most patients presented with de novo metastases (91%), with the highest rates in the EV+P (94%) and IO (91%) groups and lowest in the IO+Chemo (83%) and chemo (84%) groups (P=0.007). IO recipients were more often aged 65+ years (86%) vs. IO+chemo (67%), chemo (72%), or EV+P (77%) (P=0.003). Male predominance was greater in the IO (77%) and EV+P (76%) groups than in IO+chemo (63%) or chemo (65%) groups (P=0.007). Chemo use declined significantly from 32% in late 2023 to 9% in 2025, while EV+P rose from 39% to 62% (P<0.001).
CONCLUSIONS: In this real-world analysis, 1L mUC treatment in US community oncology practices shifted rapidly toward EV+P, with declining use of chemotherapy. These real-world patterns reflect rapid evidence of adoption and evolving treatment selection, underscoring the need to evaluate downstream outcomes and tolerability.
METHODS: Using the Integra PrecisionQ database containing ~2.2 million deidentified medical records, adults with mUC initiating 1L systemic therapy between 01-Dec-2023 and 07-Jul-2025 were assessed. Regimens were grouped as EV+pembrolizumab (EV+P, EV monotherapy (mono)/other, chemotherapy (chemo), immunotherapy (IO), and IO+chemo. Patient characteristics included age (≤65 vs. 65+ years), sex, race, ethnicity, payer, Eastern Cooperative Oncology Group performance status, metastatic type (de novo vs. recurrent), region, NCI comorbidity index, and treatment year treatment regimens. Chi-squared tests were used to compare distributions across groups
RESULTS: A total of 742 patients initiated 1L therapy with EV+P (n=407), EV mono/other (n=14), chemo (n=124), IO (n=131), IO+chemo (n=54), or other (n=12). Most patients presented with de novo metastases (91%), with the highest rates in the EV+P (94%) and IO (91%) groups and lowest in the IO+Chemo (83%) and chemo (84%) groups (P=0.007). IO recipients were more often aged 65+ years (86%) vs. IO+chemo (67%), chemo (72%), or EV+P (77%) (P=0.003). Male predominance was greater in the IO (77%) and EV+P (76%) groups than in IO+chemo (63%) or chemo (65%) groups (P=0.007). Chemo use declined significantly from 32% in late 2023 to 9% in 2025, while EV+P rose from 39% to 62% (P<0.001).
CONCLUSIONS: In this real-world analysis, 1L mUC treatment in US community oncology practices shifted rapidly toward EV+P, with declining use of chemotherapy. These real-world patterns reflect rapid evidence of adoption and evolving treatment selection, underscoring the need to evaluate downstream outcomes and tolerability.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HSD86
Topic
Health Service Delivery & Process of Care
Disease
SDC: Oncology