Treatment sequence (TS) and overall survival (OS) in patients with metastatic urothelial cancer (mUC): An observational, multicenter, real-life STATES-Bladder study.

Abstract

724 Background: mUC remains of poor prognosis despite standard first-line platinum-based chemotherapy (PBC), maintenance avelumab for ptd non progressing PBC. Enfortumab vedotin (EV) and erdafitinib offers a promising option in later lines of therapy. However all patients will not receive the whole sequence and the attrition rate remains crucial. As the therapeutic landscape evolved over the last 5 years no recent data are available on an whole mUC population including responder and non responder to PBC. This study aims to evaluate OS and treatment outcomes in real-world practice across multiple centers in France. Methods: This retrospective study included 180 patients with mUC treated with first-line PBC between January 2020 and December 2023. The primary objective was to assess OS in the overall population. Secondary objectives included OS by treatment sequence, performance status (PS), and attrition rates across treatment lines. We analyzed OS in patients receiving maintenance avelumab, those progressing to second-line therapies, and attrition at each treatment line. Additionally, OS was compared between patients with WHO PS 0-1 and WHO PS 2-3. Results: The median age was 72 years (41-91), with 81% male. Synchronous metastases were observed in 52% of patients, while 48% had metachronous metastases. The most common metastatic sites were lymph nodes (68%), lung (33%), bone (32%) and liver (21%). 44% of patients received cisplatin-based chemotherapy, while 56% were treated with carboplatin. Among patients with WHO PS 2-3 (20%), median age was 73 years (41-91), with a greater proportion having liver (25%) and bone (42%) metastases. For the entire population, median OS was 22.4 months [CI95%,17.2-26.7]. Patients receiving avelumab maintenance had a median OS of 29.0 months [CI95%,22.5-NA], while those progressing to second-line therapy showed a median OS of 15.6 months [CI95%,12.4-24.4]. Median OS for patients treated with EV at any treatment line was 26.1 months [CI95%,22.5-NA]. 58% of patients received avelumab maintenance. Attrition rates were 57% after first-line, 37% after second-line, and 9% after third-line therapy. Patients with WHO PS 0-1 had a significantly better median OS of 26.4 months [CI95%,22.5-NA], compared to 7.2 months [CI95%,6.1-13.1] for those with WHO PS 2-3 (p<0.001). Conclusions: These real-world survival outcomes are consistent with large phase 3 trials. The particularly poor prognosis of patients with WHO PS 2-3 underscores the need for innovative treatment strategies, such as EV plus pembrolizumab, as highlighted by the EV-302 study, to potentially improve outcomes in this challenging subgroup.