OBJECTIVES: The treatment landscape for aUC has recently evolved with many treatment regimens available to oncologists, all with varying efficacy and safety profiles. Using a discrete choice experiment, this study estimated oncologists’ preferences for 1L treatments and treatment attributes that would influence their prescribing decisions.

METHODS: In March 2021, practicing US oncologists participated in an online survey including 12 treatment choice tasks, each comparing 2 therapy profiles that varied in 3 treatment attributes, including treatment type/sequence and its associated grade 3/4 treatment-related adverse event (TRAE), overall survival (OS), and frequency of administration. Oncologists’ demographics and clinical management characteristics were also obtained. Random parameters logit models were used to estimate preference weights for treatment attributes and treatment regimens, including 1L chemotherapy alone, 1L immune checkpoint inhibitor (ICI) monotherapy, 1L ICI combination therapy (ICI + chemotherapy followed by ICI on disease control), and 1L ICI maintenance therapy (chemotherapy followed by ICI on disease control).

RESULTS: The study included 151 eligible medical oncologists. The majority were male (72%), White (56%), in practice >10 years (81%), and managed ≥5 aUC patients/month (92%). OS had the most influence in driving oncologists’ preferences when making prescribing decisions (74%), followed by grade 3/4 TRAEs (20%). Frequency of administration had a minor (6%) influence in treatment preferences. Among 1L treatments for aUC, 1L ICI maintenance therapy had the highest preference (73%), followed by 1L ICI monotherapy (19%), 1L ICI combination therapy (7%), and 1L chemotherapy alone (1%).

CONCLUSIONS: US oncologists highly preferred 1L ICI maintenance therapy for aUC over other 1L treatments, which is consistent with the category 1 recommendation from the National Comprehensive Cancer Network UC treatment guidelines. Future 1L aUC treatments should provide substantial OS benefit to influence oncologists’ prescribing preferences. Similar studies could be conducted to investigate oncologists’ preferences in other countries.