Department of Oncotherapy, University of Szeged, Korányi Fasor 12, H-6720, Szeged, Hungary.
Healthware Consulting Ltd., Budapest, Hungary.
Adv Ther. 2023 Dec;40(12):5475-5488. doi: 10.1007/s12325-023-02694-9. Epub 2023 Oct 13.
Data describing real-world treatment patterns in patients with metastatic urothelial carcinoma (mUC) in Central-Eastern Europe are scarce, and data from Hungary have not been published. This retrospective, nationwide, real-world study investigated patient characteristics, treatment patterns, comorbidities, and clinical outcomes in patients with mUC in Hungary.
Adults diagnosed with mUC from January 2016 through June 2021 were identified using the National Health Insurance Fund Administration database. Overall survival (OS) was estimated using the Kaplan-Meier method.
In total, 2523 patients with mUC were identified. Median follow-up was 7.1 months. Overall, 50% of patients received an identified systemic anticancer treatment; within this subgroup, first-line treatment was platinum-based chemotherapy (PBC) in 86%, non-PBC in 8%, and immune checkpoint inhibitor (ICI) in 6%. The proportion of patients receiving treatment increased from 41% in 2016 to 59% in 2020, driven by increased use of first-line PBC or first-line ICI treatment. Comorbidities were more common in patients receiving first-line ICI treatment vs PBC or non-PBC and in patients receiving carboplatin + gemcitabine vs cisplatin + gemcitabine. Overall, only 24% received a second-line treatment. Unadjusted median OS from the start of first-line treatment in the PBC, non-PBC, and ICI subgroups was 12.8, 7.5, and 6.3 months, respectively. Median OS from date of diagnosis in untreated patients was 7.8 months. OS comparisons adjusted for differences in baseline characteristics between subgroups could not be performed.
To our knowledge, this is the first study to assess treatment patterns in patients with mUC in clinical practice in Hungary, using the national health insurance database. Rates of first- and second-line treatment were consistent with those observed in other countries. Avelumab first-line maintenance treatment became available for reimbursement in Hungary in late 2022, after the study period. Given the evolving landscape of reimbursed treatments in Hungary, further analyses are warranted.
在中东欧地区，转移性尿路上皮癌（mUC）患者的真实治疗模式数据较为匮乏，且尚无来自匈牙利的数据。本回顾性、全国性真实世界研究调查了匈牙利 mUC 患者的患者特征、治疗模式、合并症和临床结局。
使用国家健康保险基金管理局数据库，确定 2016 年 1 月至 2021 年 6 月期间诊断为 mUC 的成年患者。使用 Kaplan-Meier 法估计总生存期（OS）。
共确定了 2523 例 mUC 患者。中位随访时间为 7.1 个月。总体而言，50%的患者接受了明确的系统抗癌治疗；在此亚组中，86%接受了基于铂的化疗（PBC），8%接受了非 PBC 治疗，6%接受了免疫检查点抑制剂（ICI）治疗。接受治疗的患者比例从 2016 年的 41%增加到 2020 年的 59%，这主要是由于一线 PBC 或一线 ICI 治疗的使用率增加所致。与接受 PBC 或非 PBC 治疗的患者相比，接受一线 ICI 治疗的患者以及接受卡铂+吉西他滨治疗的患者，合并症更为常见。总体而言，仅有 24%的患者接受二线治疗。未调整的一线 PBC、非 PBC 和 ICI 亚组中，从一线治疗开始的中位 OS 分别为 12.8、7.5 和 6.3 个月。未接受治疗的患者的中位 OS 为确诊后 7.8 个月。由于无法对亚组之间基线特征的差异进行调整，因此无法进行 OS 比较。
据我们所知，这是第一项使用国家健康保险数据库评估匈牙利临床实践中 mUC 患者治疗模式的研究。一线和二线治疗的比例与其他国家观察到的一致。avelumab 一线维持治疗于 2022 年末在匈牙利获得报销，研究期间之后。鉴于匈牙利报销治疗方案的不断发展，有必要进行进一步分析。
