Real-world treatment patterns and clinical outcomes among patients with advanced urothelial carcinoma in the United States

Geynisman, Daniel M.; Broughton, Edward; Hao, Yi; Zhang, Ying; Le, Trong Kim; Huo, Stephen

doi:10.1016/j.urolonc.2021.11.014

Cited by 22 publications

(17 citation statements)

References 20 publications

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“… 8-12 , 21 Recent literature shows the low utilization of systemic therapy (14%-60% of patients were not receiving systemic therapy) 22 , 23 ; however, another US-based study reported a higher utilization rate (28% did not receive 1L systemic therapy) in patients with la/mUC. 24 Present cross-sectional surveys align more toward the latter than the prior study, in which physicians estimated that less than a quarter (23%) of their patients had not received systemic therapy.…”

Section: Discussionmentioning

confidence: 74%

Evaluating Oncologists’ Practice Patterns and Decision-Making in Locally Advanced or Metastatic Urothelial Carcinoma: The US Physician PARADIGM Study

Gupta,

Costantino,

Ike

et al. 2023

The Oncologist

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Background The treatment landscape for locally advanced/metastatic urothelial carcinoma (la/mUC) has evolved. This study examined US prescribing patterns and clinical decision-making for first-line (1L) and first-line maintenance (1LM) treatment. Materials and Methods US-based oncologists (N = 150) completed an online survey on patient demographics, practice patterns, and important factors considered in 1L/1LM selection. Multivariable logistic regression was used to assess factors associated with more vs less frequent 1L/1LM prescribing. Results Physician reports estimated that 23% of patients with la/mUC had not received any systemic therapy in the previous 6 months; however, 46% received 1L, 32% received second-line, and 22% received subsequent-line systemic treatments. Of patients who were receiving 1L treatment, 72% were estimated to be receiving 1L platinum-based chemotherapy. Around 69% of patients eligible for 1LM received the treatment. Physicians categorized as frequent prescribers reported overall survival (OS), disease control rate (DCR), and rate of grade 3/4 adverse events (AEs) as factors associated with 1L treatment selection (all P < .05). OS, rate of grade 3/4 immune-mediated AEs, and inclusion in institutional guidelines were reported as attributes used in 1LM treatment selection (all P < .05). Multivariable analysis revealed OS, DCR, and rate of grade 3/4 AEs as important factors in oncologists’ 1L treatment selection; academic practice setting and use of Response Evaluation Criteria in Solid Tumors version 1.1 were associated with 1LM use (all P < .05). Conclusion OS and AEs were found to be relevant factors associated with offering 1L and 1LM treatment. Variability exists in physicians’ decision-making in the real-world setting for la/mUC.

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Section: Discussionmentioning

confidence: 74%

Evaluating Oncologists’ Practice Patterns and Decision-Making in Locally Advanced or Metastatic Urothelial Carcinoma: The US Physician PARADIGM Study

Gupta,

Costantino,

Ike

et al. 2023

The Oncologist

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“…Several other North American registries have utilised claims-based data to publish articles on UTUC although the number of published articles is low (18,19). The majority of these registries include routine data collected for health-related billing practices with analyses for the medical literature a secondary function.…”

Section: Other North American Registriesmentioning

confidence: 99%

The utility of clinical registries for guiding clinical practice in upper tract urothelial cancer: a narrative review

Kealey¹,

Snider²,

Hayne³

et al. 2023

Transl Androl Urol

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Background and Objective: Upper tract urothelial cancer (UTUC) lacks high-quality evidence to appraise current patterns of presentation, diagnosis, treatment and outcomes as a result of disease rarity and patient heterogeneity. Registries may overcome many of the challenges making clinical trials challenging in UTUC and provide answers to many of the clinical questions that afflict UTUC management. In this narrative review we aim to summarise the design of registries that have contributed to the UTUC literature, discuss their strengths and limitations and the future directions of registries in UTUC.Methods: Two independent reviewers conducted a search of the OVID MEDLINE database from July 2002-July 2022. Included articles were required to be published in peer reviewed journals and use registrybased methodology to report on UTUC. Search was limited by MeSH and key words and was limited to the English language.Key Content and Findings: One hundred and forty-four articles were identified and included as reporting on UTUC from a registry-based methodology. Articles utilising registry-based data have substantially increased over the study period with the majority of articles arising from large generalised cancer databases in North America. There has been an increase in UTUC-specific registries in the previous five years that have offered the most granular, complete analysis and these will continue to report in the coming years. The majority of published data assessed epidemiological factors and compared outcomes of treatment modalities with a small proportion of articles focusing on prognostic nomograms and quality of life. Larger cancer registries that contribute the majority of the published analysis are likely subject to significant selection bias when comparing cohorts for treatment analysis and the need for prospective UTUC specific registries is apparent. Future directions include the potential for registry-based randomised controlled trials (RCTs) and clinical quality registries (CQR) that have the ability to change practice and improve care. Conclusions:The utilisation of registry-based methodology for analysis in UTUC has increased substantially over the last 20 years. In addition to the utilisation of large cancer registries, the creation of UTUC specific registries is likely to contribute the most granular, translatable data in diagnosis and management.

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“…6 , 10 , 13 Many patients presenting with advanced UC do not receive any first-line therapy, with proportions of 28%-73% without treatment reported in different countries. 19 , 23 , 24 , 25 , 26 , 27 , 28 Potential reasons why patients may not receive first-line therapy include poor performance status and comorbidities or organ dysfunction, 26 in addition to the perceived toxicity and overall treatment burden of platinum-based chemotherapy, patient preferences, financial toxicity, and lack of access/barriers to health care, which highlights the important issue of health care disparities.…”

Section: Introductionmentioning

confidence: 99%

“… 35 , 36 , 37 , 38 However, in studies from that period, only 30%-40% of patients who received first-line chemotherapy subsequently received second-line treatment. 18 , 19 , 28 , 39 , 40 , 41 , 42 , 43 This highlights the fact that patients with advanced UC who have disease progression following platinum-based chemotherapy may deteriorate rapidly and be unable to receive subsequent lines of treatment, 44 emphasizing the importance of optimal first-line treatment.…”

Section: Introductionmentioning

confidence: 99%

Avelumab first-line maintenance treatment for advanced urothelial carcinoma: review of evidence to guide clinical practice

Grivas,

Grande,

Davis

et al. 2023

ESMO Open

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Real-world treatment patterns and clinical outcomes among patients with advanced urothelial carcinoma in the United States

Cited by 22 publications

References 20 publications

Evaluating Oncologists’ Practice Patterns and Decision-Making in Locally Advanced or Metastatic Urothelial Carcinoma: The US Physician PARADIGM Study

Evaluating Oncologists’ Practice Patterns and Decision-Making in Locally Advanced or Metastatic Urothelial Carcinoma: The US Physician PARADIGM Study

The utility of clinical registries for guiding clinical practice in upper tract urothelial cancer: a narrative review

Avelumab first-line maintenance treatment for advanced urothelial carcinoma: review of evidence to guide clinical practice

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