Tinevimbo Shiri, Max Nievaart, Simran Gil, William Perkin: Treatment patterns and clinical outcomes in patients with metastatic urothelial carcinoma in England: A retrospective observational study.. JCO 43, 740-740(2025).
Background:
n England, platinum-based chemotherapy with or without an immune checkpoint inhibitor is the standard-of-care for mUC patients. However, treatment patterns following first-line therapy remain unclear. There is a need to collect real-world data to enable an improved understanding of the clinical management of mUC in the National Health Service (NHS) and associated outcomes.
Methods:
This retrospective study obtained routine data for all patients diagnosed with mUC in England between January 2016 and December 2021 from the National Cancer Registration and Analysis Service (NCRAS). A treatment-based algorithm was developed to approximate progression to metastatic disease for those patients who had non-metastatic UC (Stage I-III). Variables collected include patient demographics, tumour characteristics, diagnostic tests, comorbidities, healthcare resource use, systemic anti-cancer therapy (SACT) and distributions of patients by lines of treatment. Kaplan-Meier methods were used to calculate overall survival (OS). Results: Of 61,816 patients diagnosed with UC between 2016 and 2021, 10,787 patients had mUC (stage IV (79.7%) at diagnosis or stage I-III (20.3%). The median age at diagnosis was 73.9 years, with 66.0% being male. Patients treated with anti-PD-L1 had a median age of 68.8 years. Only 36.5% (n = 3,942) received first-line therapy, with 24.3% (n = 959) reaching second-line therapy, while third-line therapy was delivered to 4.0% (n = 158) and fourth-line therapy to just 0.5% (n = 19) of patients with derived lines of therapy. The most common first-line regimen was ‘carboplatin + gemcitabine’ (n = 1,497; 38.0%), followed by ‘cisplatin + gemcitabine’ (n = 1,153; 29.2%). Pembrolizumab was the most common regimen administered at second line (n = 284; 29.6%) and remained the most common regimen at third line (n = 52; 32.9%). For the entire cohort, including patients that did not receive an active treatment, 12-month survival probability was 29.0%. The survival probabilities for patients treated at first-line, and reaching second-line and third-line, were 45.0%, 34.0%, and 30.0%, respectively. For the entire cohort, including patients that did not receive an active treatment, 12-month survival probability was 29.0%. The survival probabilities for patients treated at first-line, and reaching second-line and third-line, were 45.0%, 34.0%, and 30.0%, respectively.
Conclusions:
A high attrition rate in SACT was observed in mUC patients, and a poor prognosis indicated by a median OS of only 5.4 months from diagnosis. New treatment options particularly in the second-line setting could improve outcomes for patients. Further real-world studies are needed to evaluate their impact within routine clinical practice.
Data provided by Craig Knott under the HDI/NDRS partnership.