OBJECTIVES : Several immuno-oncology (IO) agents targeting programmed death (PD)-1/PD-ligand-1 have full or accelerated approval in the United States and Canada for patients with locally advanced or metastatic urothelial carcinoma (la/mUC) previously treated with or ineligible for platinum-based chemotherapy. Prognosis for these patients remains poor. The objective was to identify and summarize published literature on la/mUC treatment patterns.

METHODS : Literature databases were searched for studies published January 2013–August 2018 in English, and selected congress abstracts (2017-2018) were hand screened to identify retrospective studies reporting treatment data for adult patients with la/mUC. Implementation and reporting followed PRISMA guidelines.

RESULTS : Among 6584 database references and 1832 congress abstracts screened, 45 publications (37 unique studies: 29 manuscripts, one poster, seven abstracts) were retained after full-text review.

IO data were reported in eight studies, four with real-world data, three retrospective analyses of clinical trials, and one comparison of a clinical trial population to a real-world cohort. Studies including pre-IO launch data from Canada (2002-2016) and the US (2011-2016) reported 1.3% and 4.4% of patients, respectively, received second line IO. A more recent (2015-2017) study showed higher rates, with 7.9%, 57.8% and 64.4% of patients receiving IO in first, second, and third lines respectively.

IO discontinuation rates reported in one US study were 64.7%, 54%, and 41.4% for first, second, and third lines respectively. Two studies reported that 25-35% of patients discontinuing IO received subsequent therapy. Post-IO treatments varied widely, including chemotherapy, IO, targeted therapies, and clinical trial agents.

CONCLUSIONS : Few published studies reported IO treatment patterns. Patients treated with IO had high rates of discontinuation, with few patients receiving subsequent therapy and no clear standard of care, demonstrating high unmet need in this population. Further research of real-world treatment patterns and outcomes in la/mUC is needed to optimize therapy, particularly in the post-IO setting.