Abstract 1750P
Background
A large proportion of mUC patients (pts) do not receive systemic oncology tx. This cohort study examined pt characteristics associated with receipt of systemic tx in England.
Methods
The cohort included pts diagnosed with primary stage IV UC between 2013-2019 in the National Cancer Registration Dataset with follow-up until 31 March 2021. Systemic tx data were obtained from the Systemic Anti-Cancer Therapy dataset. Summary statistics were compared between treated and untreated pts using χ2 and Wilcoxon-Mann-Whitney tests for categorical and continuous variables, respectively. Multivariable logistic regression was performed to identify factors associated with receipt of systemic tx. Kaplan-Meier method was used to estimate median overall survival (OS) from diagnosis.
Results
10,477 mUC pts (mean age, 73.5 [SD, 11.2] years) were included; 65.2% male. Mean follow-up was 13.0 (SD, 18.0) months. 3,212 pts (30.7%) received systemic tx in any line of therapy. Treated pts were younger (67.4 vs 76.1 years), had a lower comorbidity burden (baseline mean modified Charlson Comorbidity Index score, 2.6 vs 3.8), and were less likely to have comorbid diagnoses consistent with probable cisplatin ineligibility (8.5% vs 23.6%). In multivariable analyses, pts were less likely to receive tx if they were female (OR, 0.72; 95% CI, 0.66-0.80), cisplatin ineligible (0.58; 0.48-0.69), older (0.94; 0.94-0.95), were living in the lowest income quintile (0.58; 050-0.68), had a poor performance status (0.07; 0.02-0.24), and a high comorbidity burden (0.88; 0.84-0.92). Median OS from diagnosis was 15.1 (95% CI, 14.5-15.8) and 3.4 (3.3-3.6) months for treated and untreated pts respectively.
Conclusions
Approximately 70% of mUC pts were untreated, which is a substantial proportion given the availability of effective treatments. Patients who received systemic tx were younger and healthier. Specific measures are needed to address the possible multifactorial reasons for undertreatment and improve pts management, especially for pts with significant comorbidities and poor outcomes when untreated.
Clinical trial identification
Editorial acknowledgement
Editorial support was provided by Hiba Al-Ashtal of ClinicalThinking, and was funded by Merck (CrossRef Funder ID: 10.13039/100009945) as part of an alliance between Merck and Pfizer.
Legal entity responsible for the study
Merck, as part of an alliance between Merck and Pfizer.
Funding
Merck (CrossRef Funder ID: 10.13039/100009945), as part of an alliance between Merck and Pfizer.
Disclosure
M. Kearney: Financial Interests, Institutional, Full or part-time Employment: Merck; Financial Interests, Personal, Stocks/Shares: Merck, Novartis, UCB Biopharma SPRL. H. Mahmoudpour: Financial Interests, Personal, Full or part-time Employment: Merck. P. Verpillat: Financial Interests, Personal, Full or part-time Employment: Merck Healthcare KGaA; Financial Interests, Personal, Stocks/Shares: Merck KGaA. All other authors have declared no conflicts of interest.