2386P - Factors associated with not receiving systemic treatment (tx) in patients (pts) with metastatic urothelial carcinoma (mUC): Results of a retrospective observational study in Germany

Background

Real-world studies have shown that many pts with mUC do not receive first-line (1L) systemic anticancer tx. With the expanding therapeutic landscape for mUC, identifying factors associated with undertreatment to mitigate outcome disparities is essential.

Methods

This study identified adults with an incident mUC diagnosis (dx; ICD-10 codes C65-68 + C77-79) in 2015-2019 using 2 German statutory health insurance (SHI) claims databases (2013-2020, ≈8 mil. insured). Baseline (BL) characteristics within 24 mo before dx were analyzed. After dx, pts were followed for ≥12 mo or until death. Overall survival (OS) was calculated by Kaplan-Meier estimation. Multivariable logistic regression was performed to determine variables associated with receiving 1L systemic tx.

Results

Overall, 3,226 pts with mUC (mean age, 73.8 y; male, 70.8%; mean Charlson Comorbidity Index [CCI] score, 6.3) were identified. Mean follow-up was 13.8 mo. A large portion of pts with mUC (1,892 [58.6%]) did not receive systemic tx within 12 mo of dx. Median OS after dx was notably shorter in untreated vs treated pts: 3.0 vs 13.7 mo for pts in SHI 1 and 3.6 vs 13.8 mo for pts in SHI 2, respectively. Untreated pts were significantly older (age ≥80 y: untreated, 48.2%; treated, 13.5%); had considerably more comorbidities (mean CCI: untreated, 6.8; treated, 5.5); and had a higher care level (untreated, 37.5%; treated, 11.0%). In regression analysis, older age, no prior UC-related surgery/tx, and earlier dx in the study period were associated with a higher likelihood of not receiving tx (Table).

Conclusions

Untreated pts with mUC seem to have a shorter OS than treated pts. Identified factors associated with undertreatment, such as older age and increased comorbidity, need to be addressed by offering better tolerated mUC tx and educating pts on the benefits of systemic tx. Table: 2386P

Factors associated with receiving mUC tx within 12 mo of mUC dx (multivariable logistic regression using receiving tx as dependent variable)

*Binary variable with the expressions 0 and 1.

Clinical trial identification

Editorial acknowledgement

Editorial support was provided by Katherine Quiroz-Figueroa on behalf of Clinical Thinking and was funded by Merck and Pfizer.

Legal entity responsible for the study

The authors.

Funding

This study was sponsored by Merck (CrossRef Funder ID: 10.13039/100009945), as part of an alliance between Merck and Pfizer.

Disclosure

G. Niegisch: Financial Interests, Personal, Speaker, Consultant, Advisor: Roche, Medac, Pfizer, BMS, AstraZeneca, Astellas; Financial Interests, Personal, Advisory Board: Roche, Sanofi, BMS, Merck, Pfizer, Ipsen, Janssen; Financial Interests, Personal, Other, Travel, congress registrations: Roche. M. Kearney: Financial Interests, Personal and Institutional, Full or part-time Employment: Merck; Financial Interests, Personal, Stocks or ownership: Merck, UCB. J. Krieger: Financial Interests, Personal and Institutional, Full or part-time Employment: Cytel; Financial Interests, Personal and Institutional, Advisory Board: Merck. U. Osowski: Financial Interests, Personal and Institutional, Full or part-time Employment: Merck; Financial Interests, Personal, Stocks or ownership: Merck. C. Weinhold: Financial Interests, Personal and Institutional, Full or part-time Employment: Merck. B. Deiters: Financial Interests, Personal and Institutional, Full or part-time Employment: GWQ ServicePlus AG. U. Maywald: Financial Interests, Personal and Institutional, Full or part-time Employment, at the time of study: AOK PLUS. S. Guenther: Financial Interests, Personal and Institutional, Full or part-time Employment: Merck; Financial Interests, Personal and Institutional, Stocks or ownership: Merck. T. Wilke: Financial Interests, Institutional, Full or part-time Employment: IPAM. M. Grimm: Financial Interests, Personal and Institutional, Advisory Role: Astellas Pharma, AstraZeneca, Bayer/Vital, BMS, Eisai, EUSA Pharma, Gilead, Ipsen, MSD, Novartis, Pfizer, Roche Pharma AG, Takeda, Merck; Financial Interests, Personal and Institutional, Other, travel, accommodations, and expenses: BMS, Merck; Financial Interests, Personal and Institutional, Other, Honoraria: Astellas Pharma, AstraZeneca, BMS, EUSA Pharma, Ipsen, MSD, Pfizer; Financial Interests, Institutional, Research Funding: BMS, Intuitive Surgical.