Real-World Treatment Patterns of Locally Advanced and Metastatic Urothelial Cancer (la/MUC) in France: A Secondary Database Analysis
Author(s)
Aurore Tricotel, MSc1, Khalil Karzazi, MSc1, Torsten Strunz-Mckendry, PhD2, Matthieu Trancart, MSc3, Kirsten Leyland, BA, MSc, DPhil (PhD)2, Marthe Vuillet, MA, MS2, Marie-Catherine Thomas, PharmD2, Agathe Eckenfelder, PhD3, Kahina Makhloufi, PhD, MBA3, Morgan Rouprêt, MD, PhD4, Stéphane Culine, MD, PhD5, Florence Joly, PharmD6.
1Real World Solutions, IQVIA, La Défense, France, 2Astellas Pharma Europe, Addlestone, United Kingdom, 3Astellas Pharma, Levallois-Perret, France, 4GRC 5 Predictive Onco-Uro, Sorbonne Université - Site Saint-Antoine, Paris, France, 5Department of Medical Oncology, Hôpital Saint Louis, AP-HP, Paris Cité University, Paris, France, 6Medical Oncology Department, CHU de Caen, Caen, France.
1Real World Solutions, IQVIA, La Défense, France, 2Astellas Pharma Europe, Addlestone, United Kingdom, 3Astellas Pharma, Levallois-Perret, France, 4GRC 5 Predictive Onco-Uro, Sorbonne Université - Site Saint-Antoine, Paris, France, 5Department of Medical Oncology, Hôpital Saint Louis, AP-HP, Paris Cité University, Paris, France, 6Medical Oncology Department, CHU de Caen, Caen, France.
OBJECTIVES: With the treatment landscape evolving, there is a need to understand the current real-world management of patients with la/mUC in France. Key objectives of this study include evaluating the proportion of patients initiating first-line treatment among newly diagnosed patients and describing treatment patterns.
METHODS: This was an observational, retrospective cohort study using data extracted from the Programme de Médicalisation des Systèmes d’Information, the French hospital discharge database. Adults newly diagnosed with la/mUC between 01 January 2022 and 31 December 2023 without any evidence of treatment for other types of cancer after la/mUC were included. Treatment patterns were mapped for those starting first-line treatment before 01 July 2023 (6 months minimum follow-up).
RESULTS: In total, 17,795 patients with la/mUC were included; 6,187 (34.7%) were untreated. Of the 11,372 (63.9%) who initiated first-line treatment within 3 months of diagnosis, median age was 71.2 years, 78.8% were male. Among 7,907 patients exclusively treated in acute care units (Medicine, Surgery, Obstetrics) starting first-line treatment before 01 July 2023, 91.6% (n=7,241) received chemotherapy and 8.3% (n=654) PD-1/PD-L1 inhibitor monotherapy. Avelumab maintenance after chemotherapy was received by 20.1% (n=1,589/7,907). Second-line treatment was initiated in 32.8% (n=2,596/7,907) of patients, most commonly as monotherapy with PD-1/PD-L1 inhibitors (45.3%; 1,175/2,596), chemotherapy (38.9%; 1,011/2,596), and enfortumab vedotin (EV; ~15.0%). The median interval between the completion of first-line therapy and the start of second-line therapy was 42 days. Third-line therapy was initiated in 9.6% (762/7,907) of patients, primarily chemotherapy (51.2%; 390/762), EV (27.2%; 207/762), and PD-1/PD-L1 inhibitors (~20.0%).
CONCLUSIONS: A significant proportion of la/mUC patients remain untreated (34.7%). These data underline an unmet need among first-line initiation for patients with la/mUC. While EV use has grown in later lines per guidelines, its recent approval and positioning within guidelines in combination with pembrolizumab offers a new first-line treatment option not predicated on response to chemotherapy.
METHODS: This was an observational, retrospective cohort study using data extracted from the Programme de Médicalisation des Systèmes d’Information, the French hospital discharge database. Adults newly diagnosed with la/mUC between 01 January 2022 and 31 December 2023 without any evidence of treatment for other types of cancer after la/mUC were included. Treatment patterns were mapped for those starting first-line treatment before 01 July 2023 (6 months minimum follow-up).
RESULTS: In total, 17,795 patients with la/mUC were included; 6,187 (34.7%) were untreated. Of the 11,372 (63.9%) who initiated first-line treatment within 3 months of diagnosis, median age was 71.2 years, 78.8% were male. Among 7,907 patients exclusively treated in acute care units (Medicine, Surgery, Obstetrics) starting first-line treatment before 01 July 2023, 91.6% (n=7,241) received chemotherapy and 8.3% (n=654) PD-1/PD-L1 inhibitor monotherapy. Avelumab maintenance after chemotherapy was received by 20.1% (n=1,589/7,907). Second-line treatment was initiated in 32.8% (n=2,596/7,907) of patients, most commonly as monotherapy with PD-1/PD-L1 inhibitors (45.3%; 1,175/2,596), chemotherapy (38.9%; 1,011/2,596), and enfortumab vedotin (EV; ~15.0%). The median interval between the completion of first-line therapy and the start of second-line therapy was 42 days. Third-line therapy was initiated in 9.6% (762/7,907) of patients, primarily chemotherapy (51.2%; 390/762), EV (27.2%; 207/762), and PD-1/PD-L1 inhibitors (~20.0%).
CONCLUSIONS: A significant proportion of la/mUC patients remain untreated (34.7%). These data underline an unmet need among first-line initiation for patients with la/mUC. While EV use has grown in later lines per guidelines, its recent approval and positioning within guidelines in combination with pembrolizumab offers a new first-line treatment option not predicated on response to chemotherapy.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
RWD165
Topic
Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
Oncology