OBJECTIVES: Currently, cisplatin-based chemotherapy is the preferred first line therapy (1L) for patients with metastatic urothelial cancer (mUC). However, most patients diagnosed with mUC have comorbidities and impaired functional status that limit its use. Few studies have described the overall survival (OS) of patients with mUC treated in real-world practice with non-cisplatin-based regimens. This study describes the treatment patterns and OS of patients diagnosed with mUC in the Veterans Affairs (VA) practice setting who received 1L non-cisplatin regimens consistent with the National Comprehensive Cancer Network (NCCN) v2.2015 guidelines for mUC.

METHODS: The VA Corporate Data Warehouse (01/2006-05/2017) was used to identify adults diagnosed with mUC (based on ICD9/10 diagnosis codes) who received 1L non-cisplatin regimens per guidelines. Median survival time from 1L initiation and 2-year OS rates were estimated from Kaplan-Meier analyses.

RESULTS: The study included 1,749 adults with mUC treated with 1L non-cisplatin containing regimens (median age 70 years; 99% males). Of these, 766 (43.8%) received 1L carboplatin-based regimens and 983 (56.2%) received non-carboplatin-based regimens. Among those treated with carboplatin-based regimens, carboplatin and gemcitabine was the most common regimen (321 [41.9%]); among those treated with non-carboplatin regimens, single agent gemcitabine was the most common regimen (134 [13.6%]). The median survival time was 11.8 months (95% CI 11.2; 12.3) overall, 9.9 (8.8; 10.1) for patients treated with carboplatin-based regimens (any), 9.5 (8.6; 10.3) for those treated with carboplatin and gemcitabine, and 14.5 (13.4; 15.4) for those treated with non-carboplatin based regimens. The corresponding 2-year OS rates were 29.9% (27.6; 32.2), 23.8% (20.6; 27.1), 20.4% (15.9; 25.4), and 34.6% (31.4; 37.8), respectively.

CONCLUSIONS: Survival estimates among “real-world” mUC patients in the VA practice setting who do not receive cisplatin-based treatments are suboptimal. New treatments are needed to address this unmet need.