OBJECTIVES: Systemic chemotherapy is the standard first-line (1L) treatment (tx) approach for patients with mUC; immune checkpoint inhibitors (ICIs) have commonly been used as second-line (2L) tx. In January 2021, the ICI avelumab was approved in Europe as 1L maintenance (1LM) tx in patients who are progression free following platinum-based chemotherapy. This study investigated treatment patterns in Europe prior to the approval of avelumab as 1LM tx.

METHODS: Data were obtained from the Adelphi mUC Disease-Specific Programme™, a point-in-time survey conducted between November 2020 and April 2021 in Eu5. Oncologists or urologists extracted data from medical charts of their next 8 consecutive eligible adult patients with mUC. Demographics, clinical characteristics, and tx patterns were collected. Descriptive analyses were conducted.

RESULTS: 232 physicians provided data from 1,922 patients; 73% were male and the mean age was 69 years at data collection; 81% had a primary bladder tumor at initial diagnosis. Tx received per line of therapy, either ongoing or completed, was as follows. Of 1,922 patients who received 1L tx, 86% received chemotherapy only (82% platinum based) and 10% received ICI only. Of 1,177 patients with 2L tx, 63% received ICI monotherapy, with use varying from 59% in Italy to 66% in France. 2L chemotherapy use was highest in Italy (36%) and lowest in France and Germany (both 29%). 4% received best supportive care (BSC) at 2L. At third line (3L; n=627), 43% received BSC, 40% received chemotherapy only, and 17% received ICI only.

CONCLUSIONS: Platinum chemotherapy was the 1L standard of care in the Eu5. ICI monotherapy was the most common 2L tx received. BSC was most common at 3L. Following the approval of avelumab as 1LM tx in January 2021, future real-world studies should examine how tx patterns and outcomes will evolve.