Real-world treatment patterns in patients with metastatic bladder cancer: A cross-regional analysis.

Abstract

e23321 Background: Approximately 5% of patients are diagnosed with metastatic bladder cancer (mBC), and about half relapse after cystectomy. The treatment landscape includes cisplatin-based chemotherapy, PD-1/L1 inhibitors, and other evolving targeted therapies. Despite recent advancements, survival rates for mBC remain poor. This study assessed mBC treatment patterns across regions (Europe, APAC, USA), highlighting significant regional differences in patient demographics and access to therapies. Methods: This study utilized IQVIA’s Oncology Dynamics, an oncology-specific, multi-country, cross-sectional survey, which collects patient-level oncology data using anonymized records of drug-treated cancer patients. Bladder cancer patients in the US, EU4 (France, Germany, Italy, Spain) + UK, and APAC (China, Japan, Korea) between January 2017 and September 2024 were evaluated for biomarker testing, and treatment options. Results: In this analysis, 22,812 patients were treated between 2017 and 2024, with 6,174 from Europe, 10,357 from APAC, and 6,281 from the USA. The mean age range was 71-75 years, representing 24.6% of the patients, although in Europe, the most frequent age at diagnosis was between 66-70 years. The majority of patients were male (70.5%). In the USA, the most common treatments were platinum-based chemotherapy in the first line (47.1%), immunotherapy monotherapy in the second line (79.8%), and enfortumab vedotin in the third line (45.8%). In APAC, these were platinum-based chemotherapy in the first line (65.6%), immunotherapy monotherapy in the second line (73.3%), and Nectin-4 ADCs in the third line (30.9%). While in Europe, platinum-based chemotherapy in the first line (56.2%), immunotherapy monotherapy in the second line (80.5%), and other chemotherapy schemes in the third line (38.6%). A total of 21,324 patients (94.4%) were treated with ADC across all lines and regions, with most treatments publicly funded (82%). Regarding FGFR inhibitors, 1,488 patients (5.6%) were treated, with significant public funding (86%). In Europe, 42% of patients treated with FGFR inhibitors were enrolled in clinical trials. Furthermore, 26% of patients in Europe and 11% in the USA received FGFR inhibitors in the first-line setting. A total of 419 patients (28.1%) received prior treatment with immunotherapy before FGFR inhibitors. Conclusions: This study provides valuable real-world data on treatment patterns among patients with mBC in Europe, APAC, and the USA. Real-world treatment patterns offer crucial insights for the emergence of novel therapies, helping to identify areas of unmet need. Our data indicate an increasing number of patients accessing immunotherapy across all regions and lines of therapy, while enfortumab vedotin remains the preferred option in the third-line setting. Further investigation into FGFR inhibitors is needed to understand their impact on real-world patients.