Highlights
- •An ambispective chart review of patients with la/mUC following PD-1/L1 therapy.
- •Following PD-1/L1 inhibitor discontinuation, only one third received subsequent treatment.
- •OS was longer in patients who received additional therapy following discontinuation of PD-1/L1 inhibitor.
- •Real-world outcomes in patients with la/mUC following PD-1/L1 therapy are poor.
Abstract
Introduction
The patterns of care and attrition of locally advanced or metastatic urothelial carcinoma
(la/mUC) patients eligible for systemic therapy following PD-1/L1 inhibitors are unclear.
The objective of this study was to evaluate the clinical characteristics and treatment
patterns among patients with la/mUC following discontinuation of first-line (1L) or
second-line (2L) PD-1/L1 inhibitor therapy.
Methods
An ambispective, multisite, chart review study was conducted in the United States,
including patients with la/mUC. Eligible patients had initiated and subsequently discontinued
PD-1/L1 therapy in the 1L or 2L setting for la/mUC between May 2016 and July 2018;
with follow-up through October 2019. Patient characteristics, treatments, and overall
survival (OS) were described. Patients had the option to complete a 1-time patient
reported outcomes (PRO) survey.
Results
Among 300 patients included in the chart review, 198 (66%) received 1L PD-1/L1 inhibitor
and 102 (34%) received 2L PD-1/L1 inhibitor. Following discontinuation of PD-1/L1
inhibitor therapy, 34% (n = 68) received subsequent therapy in 2L and 29% (n = 30)
in third-line (3L). The median OS post-1L PD-1/L1 inhibitor was 9.4 (95% CI 8.6-NA)
and 2.5 months (95% CI 2.24-3.50) for those who received and did not receive subsequent
therapy, respectively. Following 2L PD-1/L1 inhibitor discontinuation, the median
OS was 5.7 (95% CI 5.1-7.8) and 3.98 (95% CI 3.29-4.87) months for those who received
and did not receive subsequent therapy, respectively. Among those with PRO data, 64%
reported experiencing cancer-related pain and 29.6% received an opioid. Only 12.7%
reported having a caregiver, requiring approximately 13 h/d of service.
Conclusion
The symptom and caregiver burden are high among real-world patients with la/mUC who
discontinued 1L or 2L PD-1/L1 inhibitors and outcomes are dismal, with a minority
receiving subsequent therapy. Patterns of care in the setting of 1L maintenance avelumab
and novel agents require further investigation.
Keywords
Abbreviations:
1L (first-line), 2L (second-line), 3L (third-line), BPI-SF (Brief Pain Inventory—Short Form), ECOG PS (Eastern Cooperative Oncology Group performance status), EORTC (European Organisation for Research and Treatment of Cancer), EV (enfortumab vedotin-ejfv), FDA (Food and Drug Administration), FGFR (fibroblast growth factor receptor), HRQoL (health-related quality of life), IRB (institutional review board), la (locally advanced), m (metastatic), PD-1 (programmed death receptor-1), PD-L1 (programmed death-ligand 1), PRO (patient-reported outcome), QLQ-C30 ([Health-Related] Quality of Life Questionnaire), SD (standard deviation), SG (sacituzumab govitecan), UC (urothelial carcinoma)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 05, 2022
Accepted:
August 3,
2022
Received in revised form:
July 28,
2022
Received:
February 2,
2022
Footnotes
Prior Congress Presentations: Parts of these data have been presented at the ASCO Genitourinary Cancers Symposium 2021 Virtual Meeting, February 11-13, 2021.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
