Platinum ineligibility and survival outcomes in patients with advanced urothelial carcinoma receiving first-line treatment.

Abstract

BACKGROUND:

This study examined real-world patients with locally advanced or metastatic urothelial carcinoma (advUC) considered ineligible for platinum-containing chemotherapy in the first-line (1 L) setting.

METHODS:

This retrospective observational study used data from a nationwide (US) de-identified patient-level electronic health record-derived database. Eligible adults (≥18 years) had an advUC diagnosis on or after January 1, 2016, and initiated 1 L systemic treatment ≥90 days before December 31, 2021. Platinum ineligibility was defined as ECOG performance status ≥3, creatinine clearance <30 mL/min, or ECOG performance status of 2 and creatinine clearance <45 mL/min. Overall survival (OS) and real-world progression-free survival (PFS) were summarized using the Kaplan-Meier method.

RESULTS:

The overall population comprised 4270 patients; 477 (11%) were considered platinum ineligible; 262 (55%) received a 1 L PD-1/PD-L1 immune checkpoint inhibitor and 118 (25%) received platinum-based chemotherapy. A total of 2335 patients (55%) were platinum eligible; 677 (29%) received a 1 L PD-1/PD-L1 inhibitor and 1229 (53%) received platinum-based chemotherapy. Median OS was 13.3 months (95% CI: 12.4-14.8) in platinum-eligible and 5.1 months (95% CI: 4.2-6.4) in platinum-ineligible patients. Median PFS was shorter in platinum-ineligible (3.4 months; 95% CI: 2.9-4.0) than platinum-eligible patients (5.9 months; 95% CI: 5.5-6.2) overall and when stratified by 1 L therapy type.

CONCLUSION:

This real-world study has shown for the first time the treatment patterns and outcomes in newly diagnosed patients with advUC ineligible for platinum-based chemotherapy. These findings provide quantitative benchmarks for platinum ineligibility in the 1 L advUC setting and highlight the need for novel therapy options.

• Authors: Shilpa Gupta, Alexander Andreev-Drakhlin, Otto Fajardo, Marcella Fassò, Jorge A Garcia, Christopher Wee, Carsten Schröder
• Journal: Journal of the National Cancer Institute (J Natl Cancer Inst) (Nov 30 2023) ISSN: 1460-2105 [Electronic] United States
• PMID: 38036464 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please email: [email protected].