Individualizing first-line treatment choices in metastatic urothelial carcinoma (mUC): Results from a cross-sectional study of physicians in Europe.

Abstract

e16579 Background: The expanding first-line (1L) treatment options for mUC have introduced complexity to therapy selection. While recommended treatments offer clinical benefits, their toxicity profiles can limit routine use, and evidence on how physicians make prescribing decisions is limited. We aimed to understand physicians’ decision-making for 1L mUC treatment choice based on hypothetical patient (pt) profiles. 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 mUC in France, Germany, Italy, Spain, and the UK between Dec 2023 and Jul 2024. Physicians were asked to consider a list of pt types and select which of the 4 1L treatment options they would be most likely to prescribe for the majority of their pts with these profiles. Treatment options included platinum-based chemotherapy followed by avelumab 1L maintenance (PBC + Ave 1LM), enfortumab vedotin + pembrolizumab (EV + P), cisplatin/gemcitabine + nivolumab (Cis/Gem + Nivo), and other. All analyses were descriptive. Results: Of 238 physicians surveyed, 149 (63%) worked in academic practices, 60 (25%) in community-based practices, and 29 (12%) in other care settings. At data collection, physicians were responsible for treatment decisions for a median (IQR) of 23 (8-20) pts. Over 50% of physicians reported that they would prescribe PBC + Ave 1LM for pts with liver disease (53%) or those who are cisplatin-eligible (52%). For pts with high body mass index (BMI), or pts with low or high tumor burden, most physicians reported that they would prescribe PBC + Ave 1LM (47%, 45% and 47%, respectively). Overall, 45% of physicians stated that they would prescribe EV + P for pts with preexisting peripheral neuropathy. For frail/older pts, 34% of physicians would choose EV + P and 26% would choose PBC + Ave 1LM (Table). Conclusions: This real-world study provides contemporary insights into mUC treatment choice among practicing European physicians in an evolving therapeutic landscape. Physicians’ choice of 1L treatment was highly dependent on pt profile, demonstrating the importance of using a multifactorial decision-making strategy. Evidence-driven eligibility criteria and adherence to guidelines are crucial to inform clinical decision-making in a personalized healthcare model. Physician-reported 1L treatment choice (N=238). Pt profile, n (%) PBC + Ave 1LM EV + P Cis/Gem + Nivo Other Liver disease 126 (53) 72 (30) 11 (5) 29 (12) Frail/older 62 (26) 81 (34) 14 (6) 81 (34) High BMI 112 (47) 88 (37) 17 (7) 21 (9) Low tumor burden 108 (45) 91 (38) 24 (10) 15 (6) High tumor burden 111 (47) 90 (38) 31 (13) 6 (3) Preexisting peripheral neuropathy 76 (32) 106 (45) 15 (6) 41 (17) Only lymph node involvement 115 (48) 87 (37) 26 (11) 10 (4) Liver metastases 113 (47) 85 (36) 29 (12) 11 (5) Cisplatin-eligible 124 (52) 71 (30) 37 (16) 6 (3)