Addressing barriers to adopting first-line standards of care in la/mUC: A community practice-informed initiative.

Abstract

660 Background: Rapid advances in 1L therapy for locally advanced/metastatic urothelial carcinoma (la/mUC) have shifted standards and offer new opportunities to improve outcomes. These advances also introduce complexities in clinical decision-making including eligibility, sequencing, and AE management. In the community setting, these challenges are amplified by variations in resources, infrastructure, and care coordination. To address these challenges and support adoption of evolving standards of care, a targeted educational initiative was developed for GU oncology teams. Methods: A curriculum comprising two 30-minute CME sessions and a community-based practice-pattern analysis (PPA) survey was developed in collaboration with the Large Urology Group Practice Association (LUGPA) and the Bladder Cancer Advocacy Network (BCAN). The education launched on Medlive.com in April (Session 1) and September 2025 (Session 2) and will remain available for 12 months. Session 1 focused on guideline updates, practice implications, and AE mitigation in 1L la/mUC. The PPA survey, deployed in June 2025, assessed real-world treatment patterns and barriers to integrating newer regimens and informed development of Session 2, which highlighted strategies to address identified barriers. Outcomes were measured through pre-/post-activity assessments and evaluations. Results: To date, over 1,800 clinicians have participated in Session 1, with 93% designating their specialty as oncology/urology. Session 1 demonstrated a ~25% confidence gain in both individualizing 1L treatment selection and counseling patients on newer regimens. Most learners cited sequencing as the main challenge (25%), followed by AE management and patient counseling. Intended changes included adopting EV+P in 1L–eligible patients (42%) and reevaluating the role of platinum-based chemo (32%) in this setting. PPA survey findings (n = 95; 77% community-based) revealed cisplatin eligibility as the most influential factor guiding 1L treatment selection (65%). Among cis-eligible patients, 71% preferred platinum-based chemo ± IO, indicating lagging adoption of guideline-preferred therapy. The greatest barrier to adopting ADC+IO regimens was AE management (56%). Conclusions: A tethered, two-session curriculum, augmented by a PPA survey, demonstrated broad engagement and measurable improvements in confidence for 1L decision-making in la/mUC. Survey findings highlight a transitional phase in community practice and the need for pragmatic tools to (1) operationalize ADC+IO eligibility, (2) standardize AE monitoring/mitigation strategies, and (3) clarify sequencing. These results underscore the critical role of outcomes-driven education in closing the gap between emerging evidence, guidelines, and real-world implementation.