706P - Real-world study assessing physician rationale for initiating first-line (1L) immuno-oncology (IO) therapy for patients with advanced urothelial cancer (aUC)

Background

1L platinum-based chemotherapy is the standard of care for patients with aUC, with avelumab maintenance recommended for patients with disease control. In patients ineligible for cisplatin-containing therapy (cis ineligible) and with tumors that are PD-L1+ or platinum ineligible (US only), 1L IO treatment is an option. This study assessed physician rationale for initiating 1L IO treatment for patients with aUC.

Methods

A retrospective review of medical records was conducted by oncologists in patients ≥18 years who initiated 1L IO between 1 January 2017 and 31 May 2019. Oncologists provided rationale for treating with 1L IO and criteria for considering a patient cis ineligible, with the option to select multiple responses. Descriptive analyses were conducted.

Results

A total of 38 US and 35 UK oncologists (average 14.5 years of clinical practice) contributed data from records of 249 eligible patients (98 US; 151 UK). Cis ineligibility was the most common reason for selecting 1L IO therapy, followed by platinum ineligibility and PD-L1+ status. Oncologists selected both cis ineligible and PD-L1+ as the reasons for initiating 1L IO in only 3.1% patients in the US and 5.3% in the UK. PD-L1+ was selected as a reason for initiating 1L IO in 56.2% (US) and 33.1% (UK) of patients who tested PD-L1+ (73 US; 121 UK). Renal dysfunction was the most common criteria for determining cis ineligibility. Table: 706P

Top 3 unique reasons for selecting 1L IO and cis ineligibility criteria

*Neuropathy was the fourth most common reason in the UK behind “renal dysfunction and cardiovascular dysfunction” (4.8%).

Conclusions

This study found that criteria for determining cis ineligibility in real-world settings are consistent with published literature and, together with carboplatin ineligibility, are the main drivers of 1L IO prescribing. PD-L1 testing is mandatory per label and would have been expected to be the primary reason with cis ineligibility for selecting 1L IO. Future research should evaluate the criteria to determine platinum ineligibility, as it seems to impact physician treatment decision-making.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Pfizer and Merck KGaA, Darmstadt, Germany.

Funding

Pfizer and Merck KGaA, Darmstadt, Germany.

Disclosure

M. Ajmera: Financial Interests, Personal, Full or part-time Employment: RTI International. J. Chang: Financial Interests, Institutional, Full or part-time Employment: Pfizer; Financial Interests, Personal, Stocks/Shares: Pfizer; Financial Interests, Personal, Stocks/Shares: Bristol-Myers Squibb; Financial Interests, Personal, Stocks/Shares: Bayer. A. Hitchens: Financial Interests, Personal, Full or part-time Employment: Signant Health; Financial Interests, Personal, Full or part-time Employment: RTI Health Solutions. M. Kearney: Financial Interests, Personal, Full or part-time Employment: Merck KGaA; Financial Interests, Personal, Stocks/Shares: Merck KGaA; Financial Interests, Personal, Stocks/Shares: Novartis Pharma; Financial Interests, Personal, Stocks/Shares: UCB Biopharma SPRL. E. Esterberg: Financial Interests, Personal, Full or part-time Employment: RTI International. R. Kim: Financial Interests, Personal, Full or part-time Employment: Pfizer; Financial Interests, Personal, Stocks/Shares: Exelixis; Financial Interests, Personal, Stocks/Shares: BMS. J. Cappelleri: Financial Interests, Personal, Full or part-time Employment: Pfizer; Financial Interests, Personal, Stocks/Shares: Pfizer. G. Devgan: Financial Interests, Personal, Full or part-time Employment: Pfizer; Financial Interests, Personal, Stocks/Shares: Pfizer. N. Costa: Financial Interests, Personal, Full or part-time Employment: Pfizer; Financial Interests, Personal, Stocks/Shares: Pfizer. S. Candrilli: Financial Interests, Personal, Full or part-time Employment: RTI Health Solutions.