OBJECTIVES

Platinum-based combination chemotherapy (PBC) remains the standard first-line (1L) treatment for patients with locally advanced or metastatic urothelial cancer (mUC). Although response rates to PBC regimens are high, they are generally not durable. The objective of this study was to evaluate treatment patterns and clinical outcomes among patients with newly diagnosed locally advanced or mUC in England.

METHODS

This cohort study included patients aged ≥18 years diagnosed with primary stage III or IV UC between January 2013 and June 2017 in the National Cancer Registration and Analysis Service with follow-up until March 2018. This timeframe is prior to the adoption of immuno-oncology (IO) agents in second-line (2L).

RESULTS

A total of 10,510 patients diagnosed with locally advanced or mUC (mean age, 73.2 [SD, 11.1] years) were included; 65.8% male; 31.9% had stage III and 68.1% stage IV UC. The baseline mean modified Charlson-Deyo Comorbidity Index score was 3.4 (SD, 1.7). The mean follow-up was 14.2 (SD, 14.6) months. During follow-up, 7,924 deaths (75.4%) occurred, resulting in a median overall survival of 9.5 months from diagnosis and a 12-month survival rate of 43% (95% CI: 42%-44%); 3,506 patients (33.4%) underwent ≥1 surgical resection, and 2,893 (27.5%) received radiation therapy. Overall, 3,053 patients (29.0%) received systemic anticancer therapy, of whom 890 (29.2%) had stage III and 2,163 (70.8%) had stage IV disease. Among the latter, 377 (17.4%) received 2L, of which 49 (13.0%) received third-line (3L) treatment. PBC (93.3%) and antimetabolic agents (90.2%) were the most common 1L treatments with limited IO use in 2L (7.2%).

CONCLUSIONS

Given the low percentage of patients who receive ≥2L+ treatment, a need exists to treat mUC patients with the most effective frontline agents. Newer and more efficacious treatments are under regulatory review; these may alleviate the unmet need in this elderly population with significant comorbidities and poor outcomes.