OBJECTIVES: The treatment landscape for people with aUC is currently evolving. Treatment choice involves trade-offs between efficacy, safety, and administration schedule. This study aimed to quantify preferences for 1L treatment attributes and treatment profiles among physicians who treat patients with aUC using a DCE in 5 European countries (France, Germany, Italy, Spain, and UK).

METHODS: During August-September 2022, 498 oncologists and urologists completed an online survey including 12 treatment choice tasks, each comparing 2 hypothetical therapy choices based on treatments for aUC that varied in 5 treatment attributes: grade 3/4 treatment-related adverse events (TRAEs), 1L induction and 1L maintenance administration schedule, time to disease progression, and overall survival (OS). A mixed-effects logit model was used to estimate preference weights and compute the relative importance (RI) of each attribute. Preference shares were calculated for 4 treatment profiles and stratified by country.

RESULTS: The study included 343 oncologists (69%) and 155 urologists (31%). Most were male (72%), were in practice for >10 years (69%), and treated 5-19 patients with aUC per month (58%). OS had the strongest influence on physicians’ preferences (RI=62%), followed by frequency of grade 3/4 TRAEs (RI=27%). The remaining 3 attributes had a combined RI of 11%. Among the hypothetical treatment profiles, a sequential induction + maintenance therapy (chemotherapy followed by immune checkpoint inhibitor [ICI] maintenance therapy after disease control) profile had the largest preference share (51%), followed by ICI monotherapy (29%), ICI combination therapy (ICI + chemotherapy followed by ICI after disease control; 12%), and chemotherapy alone (9%). Across the 5 countries, the preference share for a sequential induction + ICI maintenance therapy profile ranged from 38% (Italy) to 56% (UK).

CONCLUSIONS: OS was the dominant attribute driving physicians’ choice of 1L therapy, followed by TRAEs. Future 1L therapies for aUC will need to provide substantial OS benefit to influence prescribing preferences.