Abstract 701P
Background
Urothelial cancer (UC) is the most common malignancy involving the urinary system. The objective of IMPACT UC was to assess Tx patterns and clinical outcomes among Medicare Fee-for-Service (FFS) pts with mUC treated with chemotherapy or immuno-oncology monotherapy (IO-mono) in the 1L setting.
Methods
This retrospective study used 100% Medicare FFS claims between 1 Jul 2014 and 31 Dec 2019 to identify pts aged ≥18 years with ≥1 inpatient or ≥2 outpatient visits (≥7 days apart) with a UC diagnosis (dx) and evidence of metastatic disease, based on dx codes and/or targeted Tx claims. Pts with other primary cancer dx or evidence of IO/systemic Tx before UC dx (dx index date [dID]) were excluded. Pts were required to be continuously enrolled in Medicare ≥6 months before and after dID. Line of Tx was defined using an algorithm. Pts were grouped by 1L Tx: (1) cisplatin based (cis), (2) carboplatin based (carbo), (3) IO-mono, and (4) non–platinum chemo based (non-plat). Unadjusted time on 1L Tx (TOT), time from end of 1L to beginning of 2L (TTNT), and OS were presented by type of 1L Tx.
Results
Among identified pts with mUC (N=18,888), 45.7% (n=8,630) had any identified 1L systemic Tx. Most 1L Tx pts were male (70%) and white (90%). In comparison to other Tx, pts receiving cis were younger (median age [IQR], 72 [68-76]) compared with pts receiving carbo (75 [70-81]), IO-mono (79 [73-84]), or non-plat (78 [72-83]) and had a slightly lower Charlson Comorbidity Index (median [IQR], 3 [2-5]) vs 4 (2-6) (carbo), 4 (3-7) (IO-mono), and 4 (2-6) (non-plat). Pt outcomes, including TOT, TTNT and OS, are reported in the table.
Conclusions
Over 50% of pts with mUC had no 1L Tx. Among those with 1L Tx, RW OS was longer in pts receiving 1L cis than in pts receiving the other 1L Tx. Future research should assess outcomes with the newer standard of care and evaluate unmet needs in untreated populations. Table: 701P
Outcomes
| Cis | Carbo | IO-mono | Non-plat | ||
| No. of pts | 3,247 | 2,602 | 1,730 | 1,051 | |
| OS | Median (IQR), months | 20.0 (9.6-53.7) | 11.4 (5.8-26.0) | 7.6 (2.6-22.2) | 14.3 (6.0-35.2) |
| OS rate, % | 6 Months | 87.4 | 73.8 | 55.3 | 74.9 |
| 12 Months | 67.1 | 48.7 | 38.4 | 54.9 | |
| 24 Months | 44.6 | 26.8 | 23.8 | 37.1 | |
| TOT | Median (IQR), months | 4.0 (2.6-10.8) | 4.3 (2.3-9.2) | 3.4 (1.6-7.8) | 2.5 (1.6-6.7) |
| TTNT* | Median (IQR), months | 3.1 (2.1-4.8) | 3.7 (2.1-7.3) | 3.3 (2.3-9.0) | 3.5 (2.3-8.3) |
∗ TTNT: from end of 1L to beginning of 2L.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
EMD Serono, Inc., an affiliate of Merck KGaA, Darmstadt, Germany, and Pfizer.
Funding
EMD Serono, Inc., an affiliate of Merck KGaA, Darmstadt, Germany, and Pfizer.
Disclosure
M.A. Bilen: Financial Interests, Institutional, Research Grant: Xencor; Financial Interests, Institutional, Research Grant: Bristol-Myers Squibb; Financial Interests, Institutional, Research Grant: Bayer; Financial Interests, Institutional, Research Grant: Genentech/Roche; Financial Interests, Institutional, Research Grant: Seattle Genetics; Financial Interests, Institutional, Research Grant: Incyte; Financial Interests, Institutional, Research Grant: Nektar; Financial Interests, Institutional, Research Grant: AstraZeneca; Financial Interests, Institutional, Research Grant: Tricon Pharmaceuticals; Financial Interests, Institutional, Research Grant: Genome & Company; Financial Interests, Institutional, Research Grant: AAA; Financial Interests, Institutional, Research Grant: Peloton Therapeutics; Financial Interests, Institutional, Research Grant: Pfizer; Financial Interests, Personal, Advisory Role: Exelixis; Financial Interests, Personal, Advisory Role: Bayer; Financial Interests, Personal, Advisory Role: Bristol-Myers Squibb; Financial Interests, Personal, Advisory Role: Eisai; Financial Interests, Personal, Advisory Role: Pfizer; Financial Interests, Personal, Advisory Role: AstraZeneca; Financial Interests, Personal, Advisory Role: Janssen; Financial Interests, Personal, Advisory Role: Calithera Biosciences; Financial Interests, Personal, Advisory Role: Genomic Health; Financial Interests, Personal, Advisory Role: Nektar; Financial Interests, Personal, Advisory Role: Sanofi. R. Kim: Financial Interests, Personal, Full or part-time Employment: Pfizer; Financial Interests, Personal, Stocks/Shares: Exelixis; Financial Interests, Personal, Stocks/Shares: Bristol-Myers Squibb. F.X. Liu: Financial Interests, Personal, Full or part-time Employment: EMD Serono, Inc.; Financial Interests, Personal, Stocks/Shares: EMD Serono, Inc. S. Robinson: Financial Interests, Personal, Full or part-time Employment: Avalere Health. A. Bhanegaonkar: Financial Interests, Personal, Full or part-time Employment: EMD Serono Inc.; Financial Interests, Personal, Stocks/Shares: Merck KGaA, Darmstadt, Germany. All other authors have declared no conflicts of interest.