OBJECTIVES: Radical resection remains the standard of care for MIUC. Neoadjuvant or adjuvant cisplatin-based therapy can be recommended depending on cisplatin eligibility. This survey aimed to understand the MIUC management pathway from physician perspectives.

METHODS: Real-world descriptive data were drawn from Adelphi’s MIUC Disease-Specific Programme^TM – a point-in-time survey conducted January-June 2021 with clinical/medical oncologists/urologists across in-scope geographies. Physicians completed a quantitative survey capturing their demographics, workload, treatment use, and perspectives on MIUC management.

RESULTS:

320 physicians (61% medical/clinical oncologists, 80% qualified <25 years ago, and 34% in university hospital practice) provided data. The mean number of MIUC patients currently managed was 44.7.

Physicians estimated 33% of their MIUC patients received neoadjuvant treatment only; 27% received adjuvant only, 18% received both. Neoadjuvant therapy was frequently used in Canada (43%), the UK (40%), US (38%), Spain (38%), France (37%), and Japan (34%); while adjuvant was frequently used in Italy (41%) and China (39%); there was minimal difference in Germany (28% vs. 33% respectively). Across all countries, 23% of patients did not receive adjuvant or neoadjuvant therapy, especially in Canada (33%), Japan (32%), Spain, and UK (both 26%).

Among patients eligible for adjuvant and neoadjuvant treatment who refused them (12%), physicians reported most did not want chemotherapy (62%) or were concerned about side-effects (61%) or toxicities (57%). Physicians did not prescribe adjuvant or neoadjuvant treatment in 27% of eligible patients because the risk outweighed treatment benefits.

CONCLUSIONS: There is substantive variation across countries regarding uptake of adjuvant and neoadjuvant therapy. Many eligible MIUC patients are currently not receiving them. Fear of side-effects from chemotherapies, and unfavorable risk/benefit profile are the driving factors behind physician treatment choices and patient refusals. This is likely to perpetuate significant ongoing disease burden and provide opportunity for therapies with increased benefits and better side-effects profiles to improve outcomes.