Abstract 707P
Background
Platinum-based chemotherapy (PBC) remains the cornerstone of first-line (1L) treatment of locally advanced (LA) or metastatic urothelial carcinoma (mUC). However, the optimal number of PBC cycles remains unknown. We provide a report on treatment patterns and effectiveness in the pre–immuno-oncology (IO) era.
Methods
Among all Danish UC patients with an incidence date between 2010 and 2017, we identified a population with stage IIIb or IV (n=3206) (AJCC, 8th edition) UC, 36% (n=1141) of whom received systemic anticancer therapy for their disease. Patients were stratified by the number of completed 1L cycles of cisplatin-gemcitabine (CG) or carboplatin-gemcitabine (CaG). We used the Kaplan-Meier method to estimate overall survival (OS), number of patients who lived long term (OS>2 years) on 1L therapy only and share of patients who received second-line (2L) treatment.
Results
811 patients (71 % of patients receiving systemic therapy) received CG or CaG during the study period. 71% were men, and mean age was 67.9 years (SD, 9.1 years). Patients on CG were younger (64.4 vs 70.8 years) and had a longer median OS (mOS; 14.2 vs 8.6 months) than CaG recipients (mean follow-up, 28 and 21.3 months, respectively). Only 14% and 7% of patients on CG and CaG lived long term. 35% of all LA/mUC patients receiving 1L CG or CaG treatment reached 2L treatment within ≥1 year of follow-up.
Conclusions
In an unselected nationwide Danish registry cohort, 36% of patients received systemic anticancer therapy. Also, only 35% of PBC treated patients got 2L treatment, with few patients living long term on 1L CG or CaG only. The attrition highlights the need to treat patients with LA/mUC with the most effective and tolerable frontline agents; these may alleviate the unmet need in this elderly population with poor outcomes. Table: 707P
Effectiveness of treatment in patients who received CG or CaG as 1L treatment
| 1L treatment | No. of chemo cycles | N | OS, median, months | 6, 12- and 24-months OS rates, % | OS >2 years on 1L only, n | Patients receiving 2L, n (%) |
| CG | 1-3 | 104 | 5.8 | 47, 35, 21 | 13 | 26 (25) |
| 4 | 60 | 14.5 | 80, 58, 37 | 11 | 23 (38) | |
| 5 | 50 | 14.4 | >95, 60, 36 | 9 | 16 (32) | |
| 6 | 139 | 17.0 | 92, 63, 35 | 22 | 63 (45) | |
| >6 | 189 | 16.7 | 96, 66, 39 | 23 | 84 (44) | |
| All | 542 | 14.2 | 83, 58, 34 | 78 (14.4%) | 212 (39) | |
| CaG | 1-3 | 99 | 4.5 | 42, 19, 9 | 6 | 17 (17) |
| 4 | 35 | 7.9 | 74, 29, 11 | <5 | 9 (26) | |
| 5 | 35 | 10.6 | 80, 46, 29 | <5 | 8 (23) | |
| 6 | 76 | 12.8 | >95, 53, 24 | 5 | 31 (41) | |
| >6 | 31 | 11.0 | >95, 45, 23 | <5 | 11 (35) | |
| All | 276 | 8.8 | 71, 36, 17 | 20 (7.2%) | 76 (28) |
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
J. Bjerggaard Jensen: Financial Interests, Institutional, Research Grant: Medac; Financial Interests, Institutional, Research Grant: Photocure; Financial Interests, Institutional, Research Grant: ASA; Financial Interests, Institutional, Research Grant: Ferring; Financial Interests, Institutional, Research Grant: Cephaid; Financial Interests, Personal, Other, Personal Fees: Photocure; Financial Interests, Personal, Other, Personal Fees: ASA; Financial Interests, Personal, Other, Personal Fees: Olympus; Financial Interests, Personal, Other, Personal Fees: Ferring; Financial Interests, Personal, Other, Personal Fees: Cephaid; Financial Interests, Personal, Other, Personal Fees: Medac; Financial Interests, Personal, Other, Personal Fees: Pfizer; Financial Interests, Institutional, Other, Personal Fees: Merck Sharp & Dohme; Financial Interests, Personal, Other, Personal Fees: AstraZeneca; Financial Interests, Personal, Other, Personal Fees: Ambu; Financial Interests, Personal, Other, Personal Fees: Intuitive Surgery; Non-Financial Interests, Personal, Other, Personal Fees: Roche. M. Duus Hjortsoe: Financial Interests, Personal, Full or part-time Employment: Pfizer. M.E. Madsen: Financial Interests, Personal, Full or part-time Employment: Incentive. J. Olsen: Financial Interests, Personal, Full or part-time Employment: Incentive. All other authors have declared no conflicts of interest.