Milloy Neil, Kirker Melissa, Unsworth Mia, Montgomery Rachel, Kluth Caspian, Kearney Mairead, Chang Jane
Adelphi Real World, Adelphi Mill, Grimshaw Lane, Bollington, Macclesfield, Cheshire, United Kingdom.
Pfizer, New York, NY.
Clin Genitourin Cancer. 2024 Feb;22(1):e136-e147.e1. doi: 10.1016/j.clgc.2023.09.010. Epub 2023 Oct 2.
The global treatment landscape for metastatic urothelial cancer (mUC) is evolving, with the recent approval of several new therapeutics. To enable informed treatment decisions, a need exists to understand both treatment patterns and how physicians determine platinum-based treatment eligibility status. This study investigated physicians' current approaches to first-line (1L) chemotherapy, treatment patterns, and assessment of platinum-based treatment eligibility of patients with mUC in real-world clinical practice.
Data were derived from the Adelphi mUC Disease Specific Programme™, a large, independent, multinational, cross-sectional survey of physicians and their consulting patients with mUC presenting in a real-world clinical setting, conducted in France, Germany, Italy, Spain, and the United Kingdom between November 2020 and April 2021. Physicians completed record forms for their next 8 consecutively consulting patients (≤3 1L, ≤2 second-line, and ≤3 third-line) with a physician-confirmed diagnosis of mUC, reporting data on demographics, clinical characteristics, eligibility for platinum-based chemotherapy, and treatments received.
Overall, 232 physicians provided data for 1922 patients. Renal function impairment (72%), Eastern Cooperative Oncology Group performance status (59%), and age (38%) were the most commonly reported criteria physicians used to determine eligibility for platinum-based chemotherapy. At 1L, 82% of patients received platinum-based chemotherapy (cisplatin, 51%; carboplatin, 31%) and 10% received immune checkpoint inhibitor (ICI) therapy. At second-line, 12% received platinum-based chemotherapy, 63% ICI therapy, and 21% non-platinum-based chemotherapy. At third-line, 4% received platinum-based chemotherapy, 41% best supportive care only, and 36% other non-platinum-based chemotherapy.
The results of this real-world study indicate that in accordance with European guidelines, the majority of patients with mUC received standard-of-care 1L platinum-based chemotherapy and use of ICIs was limited. Future research should assess how physicians' perceptions toward determining platinum eligibility status evolve with newer guideline recommendations and the introduction of new therapy options for mUC.
随着几种新疗法的近期获批，转移性尿路上皮癌（mUC）的全球治疗格局正在不断演变。为了做出明智的治疗决策，有必要了解治疗模式以及医生如何确定铂类治疗的 eligibility 状态。本研究调查了医生在现实临床实践中对一线（1L）化疗、治疗模式以及 mUC 患者铂类治疗 eligibility 的评估的当前方法。
数据来自阿德尔菲 mUC 疾病特定项目™，这是一项针对在现实临床环境中就诊的医生及其咨询的 mUC 患者的大型、独立、跨国横断面调查，于 2020 年 11 月至 2021 年 4 月在法国、德国、意大利、西班牙和英国进行。医生为其接下来连续 8 名经医生确诊为 mUC 的咨询患者（≤3 名一线、≤2 名二线和≤3 名三线）填写记录表格，报告人口统计学、临床特征、铂类化疗的 eligibility 以及接受的治疗数据。
总体而言，232 名医生为 1922 名患者提供了数据。肾功能损害（72%）、东部肿瘤协作组体能状态（59%）和年龄（38%）是医生用于确定铂类化疗 eligibility 最常报告的标准。在一线治疗中，82%的患者接受了铂类化疗（顺铂，51%；卡铂，31%），10%的患者接受了免疫检查点抑制剂（ICI）治疗。在二线治疗中，12%的患者接受了铂类化疗，63%的患者接受了 ICI 治疗，21%的患者接受了非铂类化疗。在三线治疗中，4%的患者接受了铂类化疗，41%的患者仅接受了最佳支持治疗，36%的患者接受了其他非铂类化疗。
这项现实世界研究的结果表明，根据欧洲指南，大多数 mUC 患者接受了标准治疗的一线铂类化疗，ICI 的使用有限。未来的研究应评估随着更新的指南建议以及 mUC 新治疗方案的引入，医生对确定铂类 eligibility 状态的看法如何演变。
