OBJECTIVES : The advent of immuno-oncology (IO) therapy has significantly altered the treatment landscape for locally advanced or metastatic urothelial carcinoma (UC). This study sought to describe characteristics and treatment patterns for UC patient population treated in the US community oncology setting.

METHODS : This was a retrospective study of the US Oncology Network’s electronic healthcare record database. Adult locally advanced or metastatic UC patients receiving either first-(1L), second- (2L) or third-line (3L) systemic chemotherapy or IO therapy between 01 January 2015 and 30 April 2017 were included in the analysis and followed until 30 June 2017.

RESULTS : Among 523 patients who initiated 1L treatment, the mean age was 71.5 years (SD: ±10.9), 73.2% were aged ≥65 years, 86.4% were Caucasian and 76.5% were male. Systemic chemotherapies were received by 95.0% (n=497) of 1L patients, with the most common regimens being platinum-based: carboplatin/gemcitabine (27.7%), cisplatin/gemcitabine (26.0%), carboplatin/paclitaxel (7.3%) and cisplatin alone (5.9%). IO therapy was received by 5% (n=26) of patients in 1L. Most patients who initiated 2L (n=241) or 3L (n=50) treatments received IO-based regimens, 56.8% and 68.0%, respectively. Median treatment duration by line was 11.6, 10.1 and 12.1, respectively. Among patients who discontinued treatment, 33.5% of 1L and 18.3% of 2L received subsequent therapy.

CONCLUSIONS : These findings provide important insight into the epidemiology and treatment patterns of locally advanced or metastatic UC patients in community oncology setting in the US. Substantial heterogeneity in regimens administered within each line of therapy was observed. While platinum-based chemotherapy was the predominant 1L treatment, recently-approved IO therapies were increasingly incorporated as alternatives to chemotherapy as second- and subsequent lines of therapy. It would be important to understand the tolerability and side effect profile of these IO therapies in real-world clinical practice for this mainly elderly patient population with significant unmet need.