Introduction:

Avelumab, a PD-L1 inhibitor, is now the standard-of-care first-line (1L) maintenance treatment (tx) for patients with Ia/mUC whose disease has not progressed following tx with platinum-based chemotherapy (PBC). It is important to understand factors associated with the use of 1L PBC for Ia/mUC and potential tx barriers. This cross-sectional survey evaluated practice patterns and physician decision-making for 1L tx and 1L maintenance tx for Ia/mUC among US medical oncologists. The current results focus on 1L PBC use.

Methods:

A total of 150 oncologists based in the US were recruited to complete an online survey (September-October 2021) on patient demographics, practice patterns, and important factors considered in 1L PBC selection/use. Physicians were asked about the importance of factors used to determine 1L tx (11 different factors), if patients were cisplatin or platinum ineligible, and about the use of creatinine clearance (CrCl) cutoffs to determine ineligibility. Physicians were asked about their clinical decision-making for patients with la/mUC seen in their practice in the previous 6 months. Descriptive analyses were conducted.

Results:

Physicians reported that, on average, 54% of patients were cisplatin-eligible, 27% were carboplatin-eligible, and 19% were platinum-ineligible. Poor renal function, poor performance status, and advanced age were the 3 most important characteristics in determining 1L tx selection if patients were considered cisplatin/platinum ineligible. Physicians reported CrCl cutoffs for cisplatin- vs platinum-ineligibility (Table). Based on physician reports, in the 6 months prior, on average 46% of their patients with la/mUC were receiving a 1L systemic tx regimen, 32% were receiving 2L, and 22% were receiving 3L or later. Of those receiving 1L tx, on average, 72% were receiving 1L PBC (cisplatin-based regimens: 49%; carboplatin-based regimens: 23%). On average, among la/mUC patients treated with 1L PBC, 49% were eligible for and received 1L maintenance tx, 19% were eligible for and did not receive 1L maintenance, 22% started 2L tx (no 1L maintenance tx), and 10% did not continue any systemic tx.

Conclusion:

Physicians reported that >80% of their patients were cisplatin or carboplatin eligible. Physicians’ consensus around cut-offs for platinum-based chemo eligibility varied. Survey results also indicated that among la/mUC pts who received systemic tx, 46% received 1L tx in the past 6 months. Ongoing and future work on the standardization for platinum eligibility criteria is needed to ensure that all eligible patients with la/mUC can benefit from PBC and receive optimal 1L tx.

Funding: This research was funded by EMD Serono (CrossRef Funder ID: 10.13039/100004755) as part of an alliance between the healthcare business of Merck KGaA, Darmstadt, Germany and Pfizer.