TREATMENT PATTERNS AMONG FGFR-POSITIVE METASTATIC UROTHELIAL CARCINOMA PATIENTS: A NORSTELLALINQ CLAIMS AND EHR ANALYSIS
Author(s)
Shefali Patel, MS1, Allison Perry, PhD, MHS2, Atharva Manjrekar, MS3, Rahul Das, PhD2, ilan behm, MPH4.
1Norstella, Ferndale, MI, USA, 2Norstella, New York, NY, USA, 3Norstella, West Hartford, CT, USA, 4Norstella, Englewood, CO, USA.
1Norstella, Ferndale, MI, USA, 2Norstella, New York, NY, USA, 3Norstella, West Hartford, CT, USA, 4Norstella, Englewood, CO, USA.
OBJECTIVES: To characterize treatment initiation and sequencing following an FGFR-positive result among patients with metastatic urothelial carcinoma using linked claims and electronic health record (EHR) data.
METHODS: A retrospective cohort analysis was conducted using NorstellaLinQ US real-world linked open claims, structured EHR, and clinical notes (January 2021-December 2025). FGFR-positive patients were identified via human-in-the-loop large language model (LLM) extraction of FGFR biomarker entities from clinical notes and structured reference laboratory records. The analytical cohort required ≥1 prior line of systemic therapy before the index FGFR-positive date and ≥90 days of follow-up. Post-test treatment was classified within 180 days using a mutually exclusive hierarchy: FGFR-targeted therapy (erdafitinib), antibody-drug conjugate (ADC), checkpoint inhibitor (CPI), chemotherapy, or no systemic therapy observed. Treatment sequences were characterized by most recent prior regimen category.
RESULTS: Among 629 FGFR-positive patients with ≥1 prior systemic therapy, 283 (45.0%) received no systemic treatment within 180 days of the index FGFR-positive result. Among treated patients (N=346), ADCs were the most common post-test therapy (38.7%), followed by erdafitinib (29.5%), CPIs (24.0%), and chemotherapy (7.8%). Median time to treatment initiation was shortest for erdafitinib (4 days [IQR 0-32]) compared with ADCs (12 days) and CPIs (13 days). Erdafitinib use was more common among patients previously treated with platinum-based chemotherapy than prior CPI therapy (18.7% vs. 11.4%). Use of erdafitinib peaked in 2022 (23.6%), declined in 2023 (9.9%), and stabilized at approximately 15% during 2024-2025, paralleling changes in the mUC treatment landscape.
CONCLUSIONS: Nearly half of FGFR-positive mUC patients with prior systemic therapy received no systemic treatment within 180 days of biomarker identification, highlighting a substantial gap between biomarker detection and subsequent treatment. ADCs surpassed erdafitinib as the most common post-test regimen, reflecting the evolving therapeutic landscape for mUC. Greater use of erdafitinib among previously platinum-treated patients is consistent with treatment selection aligned with current clinical practice.
METHODS: A retrospective cohort analysis was conducted using NorstellaLinQ US real-world linked open claims, structured EHR, and clinical notes (January 2021-December 2025). FGFR-positive patients were identified via human-in-the-loop large language model (LLM) extraction of FGFR biomarker entities from clinical notes and structured reference laboratory records. The analytical cohort required ≥1 prior line of systemic therapy before the index FGFR-positive date and ≥90 days of follow-up. Post-test treatment was classified within 180 days using a mutually exclusive hierarchy: FGFR-targeted therapy (erdafitinib), antibody-drug conjugate (ADC), checkpoint inhibitor (CPI), chemotherapy, or no systemic therapy observed. Treatment sequences were characterized by most recent prior regimen category.
RESULTS: Among 629 FGFR-positive patients with ≥1 prior systemic therapy, 283 (45.0%) received no systemic treatment within 180 days of the index FGFR-positive result. Among treated patients (N=346), ADCs were the most common post-test therapy (38.7%), followed by erdafitinib (29.5%), CPIs (24.0%), and chemotherapy (7.8%). Median time to treatment initiation was shortest for erdafitinib (4 days [IQR 0-32]) compared with ADCs (12 days) and CPIs (13 days). Erdafitinib use was more common among patients previously treated with platinum-based chemotherapy than prior CPI therapy (18.7% vs. 11.4%). Use of erdafitinib peaked in 2022 (23.6%), declined in 2023 (9.9%), and stabilized at approximately 15% during 2024-2025, paralleling changes in the mUC treatment landscape.
CONCLUSIONS: Nearly half of FGFR-positive mUC patients with prior systemic therapy received no systemic treatment within 180 days of biomarker identification, highlighting a substantial gap between biomarker detection and subsequent treatment. ADCs surpassed erdafitinib as the most common post-test regimen, reflecting the evolving therapeutic landscape for mUC. Greater use of erdafitinib among previously platinum-treated patients is consistent with treatment selection aligned with current clinical practice.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
RWD60
Topic
Clinical Outcomes, Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Distributed Data & Research Networks, Health & Insurance Records Systems
Disease
Oncology, Urinary/Kidney Disorders