Abstract 1767P
Background
The approval of immune checkpoint inhibitors (ICIs) in metastatic urothelial cancer (mUC) has changed treatment landscape. Outcomes for patients remain poor. Many patients progress on first line chemotherapy and don’t receive ICI. Here we compare outcomes for patients according to sequencing of therapies.
Methods
This retrospective audit was performed at Barts Cancer Institute for consecutive patients from January 2010 until March 2022. The primary objective was to determine the outcome of patients and exposure to systemic therapy.
Results
252 patients with bladder and upper tract cancers were included. 239 patients received 1st line systemic therapy for metastatic UC (94%) and other bladder cancer histologies (6%).74% of patients were male. Median age was 50 years (range 28-85). 36% had visceral metastases at diagnosis. Median PFS and OS for UC was 7.5 months and 18.5 months, compared to 4.2 months and 10.1 months in those that had non-UC. Chemotherapy was the most common 1st line therapy. Response rates to first line therapy for UC was 46%. Median number of cycles of chemotherapy was 5. The most common 2nd line therapy for UC was ICI (65%), with a RR of 26% (20% is expected). Median number of cycles of ICI was 5.5. 33% of patients with UC received 3rd line therapy of any kind, with a RR of 33%. Chemotherapy was the most common 3rd line therapy (53%). Overall, 8% of UC patients received targeted therapy. Baseline visceral metastases and performance status is associated with poor outcome. Only 64% and 14% of patients with non-UC tumours received 2nd or 3rd line therapy, respectively.
Conclusions
The introduction of ICIs, antibody drug conjugates and targeted therapy have had an impact on the treatment landscape, although many patients are not able to receive subsequent therapy. Prognostic outcomes such as visceral metastases determine outcome, irrespective of treatment type.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Thomas Powles.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.