Differences in patient (pt) characteristics and therapy choice across treatment (tx) groups in locally advanced or metastatic urothelial cancer (la/mUC) in the US: A survey on unmet patient needs.

Abstract

e16561 Background: Although the tx landscape for la/mUC has evolved with the emergence of novel therapies, a gap remains in understanding physician perspectives on tx selection and unmet needs in pts. We compared first-line (1L) tx choice and clinical characteristics in pts with la/mUC in the US. Methods: Data were drawn from the Adelphi Real World mUC Disease Specific Programme, a cross-sectional survey of medical oncologists/urologists and their pts with la/mUC conducted in the US from January to July 2024. Physicians reported pt characteristics, tx regimens, and reasons for tx choice. Tx groups were defined as pts receiving 1L platinum-based chemotherapy (PBC) only, PBC + maintenance avelumab (Ave), enfortumab vedotin (EV) + pembrolizumab (P), cisplatin-gemcitabine (Cis-Gem) + nivolumab (Nivo), or any other regimen at data collection. Bivariate tests and pairwise (PW) comparisons were used. Results: 49 physicians provided data on 346 pts. Mean pt age was 66.2 (SD, 10.13) years and 71% were male. Pts in the Cis-Gem + Nivo group had a higher body mass index (BMI) vs the PBC only (p=0.0004, PW T-test [TT]), EV + P (p=0.0003, PW TT), and other 1L tx (p=0.0002, PW TT) groups. A smaller proportion of the EV + P group had bone metastases vs the PBC only (22% vs 48%; p=0.0033, PW Fisher exact [FE]) and Cis-Gem + Nivo (73%; p=0.0027, PW FE) groups. Of pts receiving 1L tx at data collection (n=295), moderate to severe pain was reported in 31%, and fatigue was reported in 32%, most commonly in the PBC + Ave group (81%; p=0.0003, FE). Reasons for tx choice had limited variation across groups, but a significant difference was seen in overall survival as a reason for 1L tx choice (p=0.0036, FE). Conclusions: Tx choice was driven by regimen efficacy despite differences in pt characteristics. Fatigue was most commonly reported in the PBC + Ave group. An individualized tx approach that maintains pt well-being is required when selecting from the increasing number of available 1L tx options. Pt characteristics and reasons for choice of 1L regimen received at data collection. PBC onlyn=93 PBC + Aven=24 EV + Pn=47 Cis-Gem + Nivon=13 Othern=169 Bivariate p value Age, mean (SD), years 68.0 (8.4) 63.6 (8.4) 64.0 (9.2) 63.8 (7.5) 67.9 (12.6) 0.0617 (AN) BMI, mean (SD), kg/m 2 25.9 (2.7) 25.4 (4.3) 24.8 (3.0) 29.3 (5.5) 25.3 (3.4) 0.0006 (AN) Receiving 1L tx at data collection n=93 n=16 n=45 n=11 n=130 Bone metastases, n (%) 45 (48) 10 (63) 10 (22) 8 (73) 32 (25) <0.0001 (FE) Fatigue, n (%) 27 (29) 13 (81) 19 (42) 2 (18) 33 (25) 0.0003 (FE) Reason for choice: Rapid onset of action 47 (51) 12 (75) 23 (51) 8 (73) 49 (38) 0.0063 (FE) Reason for choice: Progression-free survival 36 (39) 10 (63) 24 (53) 4 (36) 49 (38) 0.2842 (FE) Reason for choice: Response rate 35 (38) 10 (63) 25 (56) 5 (45) 44 (34) 0.0794 (FE) Reason for choice: Overall survival 29 (31) 10 (63) 24 (53) 5 (45) 35 (27) 0.0036 (FE) AN = ANOVA .