There is no universally accepted standard therapy for second-line (2L) treatment of metastatic bladder cancer (mBC). We sought to evaluate treatment patterns and outcomes of patients (pts) receiving 2L treatment for mBC.
We identified pts receiving initial mBC treatment during an index period from January 2010-June 2014 by review of electronic health records (EHR) of McKesson Specialty Health/US Oncology, with follow-up through July 2016. Patients who subsequently received 2L therapy were included in this analysis. The Kaplan-Meier method was utilized to evaluate outcomes from 2L treatment initiation.
Of 1155 pts receiving 1L treatment during the index period, 391 (33.9%) pts received 2L treatment and were eligible for analysis. The median age was 70 years (range 36-89) and 81.1% were men. Median time to initiation of 2L therapy following mBC diagnosis was 7.8 months(mos). 2L therapy was used in 33.6% of pts who received 1L cisplatin(cis)-based therapies and 34.0% of those who received other 1L therapies. 51.4% of 2L pts received combo-therapy; the common (>5% of total 2L utilization) regimens were carboplatin(carbo)/gemcitabine(gem) (14.8%), carbo/paclitaxel(pac) (12.0%), and cis/gem (7.7%). 48.6% of 2L pts received monotherapy; the common regimens were pac (17.4%), docetaxel (10.5%), pemetrexed (8.2%), and gem (6.6%). For the composite outcome of third-line therapy initiation or death, the median time-to-event for all 2L regimens was 5.2 mos (95% confidence interval [CI], 4.5 to 6.0). Median overall survival (OS) for all 2L regimens was 9.4 mos (95% CI, 8.2 to 11.1). Time-to-event outcomes were significantly different across the various regimens (p = 0.0005).
This real-world data provides important insights into patterns of care and outcomes for 2L mBC pts. These results concur with other observational studies in this time frame, suggesting that only one third of 1L mBC pts progress to 2L treatment. Taxane and platinum-based regimens predominated in the 2L, although patterns of treatment were consistent with prior research showing that no clear standard of care exists for these pts. Monotherapy and combination regimens are utilized in equal proportions, both producing poor outcomes for mBC pts.
Clinical trial identification
Legal entity responsible for the study
Kyle Flannery et al. had final responsibility for conduct and reporting of this study.
Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA
K. Flannery: Employee of Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA. J. Black-Shinn, M. Boyd, N. Robert: Employees of McKesson Specialty Health/The US Oncology Network, which received funding for this research from Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA. A. Kamat: Research funding: Fkd Industries: Photocure, Merck, Heat Biologics, Consulting or advisory role: Cepheid, Photocure, Telesta Therapeutics, Sanofi, Merck, Abbott Molecular, Theralase, Heat Biologics, Spectrum Pharmaceuticals, Oncogenix.