There is limited data available on real-world treatment (tx) patterns for patients with mUC. This study describes the tx characteristics and outcomes of mUC patients.
This was a retrospective cohort study of 9,436 patients from a U.S. insurance claims database between 1/1/2005-6/30/2015. Adult patients with ≥ 2 diagnosis codes for UC, ≥ 2 diagnosis codes for metastasis (first metastasis = index date), ≥ 6 months of continuous enrollment pre-index and no evidence of cystectomy were included. A subset of 5,531 (58.6%) had survival data available.
The population was majority male (74%); with a mean age of 70. Among chemotherapy treated (T) patients (N = 3,750), the median number of days to tx initiation was 28; and among untreated (NT) patients (no therapy observed), the median follow-up was 218 days. NT compared to T patients, were older (72 vs. 67) and had higher National Cancer Institute (NCI) comorbidity score (1 vs. 0.8). Among T patients, gemcitabine (GEM; 48%), carboplatin (CAR; 42%), cisplatin (CIS; 25%), and paclitaxel (PAC; 21%) were the 4 most common txs included in a first-line (1L) regimen. Patients treated with CIS were younger (62 vs. 69 and 68) and healthier (NCI comorbidity score 0.7 vs. 1.1, and 1.0) vs. patients treated with CAR and other treatments (OT), respectively. Second-line (2L) tx was observed in 1,204 (13%) patients. A greater proportion of 1L CIS patients started 2L therapy (31%) vs. CAR (29%) and OT (18%). GEM (30%), CAR (30%) and PAC (30%) were the most common txs included in a 2L regimen. In the overall survival analysis, CAR patients have poorer survival than CIS or OT patients (median months from 1L initiation: 14.4 vs. 19.5 and 16.8, respectively; log rank p = 0.001).
The majority (60%) of mUC patients did not receive chemotherapy in this study. NT patients had characteristics similar to CAR patients, while those receiving CIS were younger, healthier, and had better outcomes. These findings provide further insight into treatment strategies in real world settings and highlight the unmet need in this patient population.
Clinical trial identification
Legal entity responsible for the study
E. Malangone-Monaco, K. Wilson, H. Varker: Employee of Truven Health Analytics, Inc., which was paid by Genentech to conduct this study. S. Satram-Hoang: Consultant to Genentech, which provided funding for this research. S-W. Lin, D. Tayama, S. Ogale: Employed by Genentech and own Genentech/Roche stock.