OBJECTIVES

To assess baseline characteristics and treatment patterns among patients in the US Veterans Health Administration with metastatic urothelial cancer (mUC) treated with second-line (2L) therapy.

METHODS

This retrospective study identified newly diagnosed treatment-naive adult patients with mUC who received ≥2 lines of therapy from 01Oct2013-31Jan2018. The 2L therapy was defined by the earliest new therapy added >30 days after first-line (1L) therapy start, regimen switch, or a new/existing regimen beginning >90 days after prior regimen end (index date=2L therapy start date). Patients were required to have continuous health plan enrollment from ≥6 months pre–initial UC diagnosis date until ≥2 months post–index date with follow-up until death or study end. Duration of 2L therapy was assessed as period between index date and earliest of last prescription’s end date, third-line therapy start date, or follow-up end and was compared among patients treated with chemotherapy vs those treated with immunotherapy using log-rank tests of Kaplan-Meier curves.

RESULTS

Of 149 patients with mUC, 64% and 36% were treated with 2L chemotherapy and immunotherapy, respectively. Patient characteristics were similar; ≥75% were white men aged ≥65 years with mean Charlson comorbidity index of ≥5 during the 6 months prior to index date. During the pre-index period, time from 1L to 2L therapy was significantly longer in the immunotherapy cohort (230 vs 150 days; p=0.0055). Carboplatin+gemcitabine (24%) and docetaxel (14%) were the most commonly recommended 2L chemotherapy regimens. Patients prescribed immunotherapy had a significantly longer duration of 2L therapy during the follow-up period than those administered chemotherapy (median, 196 vs 91 days; p=0.0003).

CONCLUSIONS

Current study findings suggest that mUC patients treated with IO regimens had significantly prolonged treatment duration relative to chemotherapy-treated patients in the 2L setting. Future research should examine the impact of these newer therapies on clinical and economic benefits.