1985P - Retrospective database analysis of real-world treatment patterns and sequencing in locally advanced or metastatic urothelial carcinoma patients receiving sacituzumab govitecan

Background

The treatment (tx) landscape for locally advanced or metastatic urothelial carcinoma (la/mUC) is evolving rapidly, with recent US FDA approvals of the antibody drug conjugates (ADCs) enfortumab vedotin (EV) and sacituzumab govitecan (SG; as second-line plus [2L+] treatment), as well as the combination of EV and pembrolizumab (EV+P), expected to be first-line (1L) standard of care (SOC). This study characterizes tx patterns and sequencing of ADCs in real-world clinical practice.

Methods

This study used the nationwide (US) Flatiron Health electronic health record (EHR)–derived de-identified database. Patients (pts) aged ≥ 18 yrs with la/mUC defined by ICD codes who had initiated 1L tx from January 2015 to August 2023 were included, with 3 months of data accrual to November 2023. Pts with another primary cancer or who received any clinical trial drug were excluded. Systemic tx for la/mUC were summarized by line of therapy (LOT) to the fifth line (5L). Tx sequencing overall and by SG LOT were assessed.

Results

The study included 5452 pts with la/mUC. Median age was 73 yrs and 73% were male. In total, 647 unique patients (n = 113 SG; n = 626 EV) received ADCs. In 1L and 2L, most la/mUC pts received platinum-based chemotherapy (55% and 15%, respectively) or a programmed death (ligand)1 (PD-[L]1) inhibitor (35% and 59%, respectively). About 80% of pts who received SG in third (3L) or fourth line (4L) had received EV in the prior LOT. In pts treated with SG in 2L, the highest proportion received a prior PD-(L)1 inhibitor (41%), followed by EV (29%), and platinum-based chemotherapy (24%) in 1L (Table).

Conclusions

Most patients treated with SG had received EV in the immediate prior line. As the tx landscape evolves with the expected adoption of 1L EV+P as SOC, updated analyses will provide further insights on tx patterns and sequencing in 2L+ la/mUC treatment in real-world clinical practice. Table: 1985P

Treatment sequencing by SG treatment line

Only 5 patients received SG in 1L and are not included in this table. ^aCarboplatin or cisplatin. ^bMonotherapy or combination therapy. ^cPaclitaxel or docetaxel, as monotherapy or combination therapy. ^dBesides MVAC (methotrexate, vinblastine, Adriamycin, and cisplatin) and the above treatments.

Clinical trial identification

Editorial acknowledgement

Editorial support was provided by Parexel, sponsored by Gilead.

Legal entity responsible for the study

Gilead Sciences, Inc.

Funding

Gilead Sciences, Inc.

Disclosure

R. Mamtani: Financial Interests, Personal, Advisory Board: BMS, Astellas/Seagen, Merck, King & Spalding; Financial Interests, Institutional, Research Grant: Astellas; Financial Interests, Institutional, Funding: Merck. J. Katz: Financial Interests, Personal, Full or part-time Employment: Gilead Sciences, Inc.; Financial Interests, Personal, Stocks/Shares: Gilead Sciences, Inc. R. An: Financial Interests, Institutional, Full or part-time Employment: Genesis Research Group. F. Boateng: Financial Interests, Personal, Stocks/Shares, Employee stocks: Gilead Sciences. Y. Ghazi: Financial Interests, Personal, Full or part-time Employment: Gilead Sciences. M. Brockman: Financial Interests, Personal, Full or part-time Employment: Gilead Sciences, Inc. M. Sierecki: Financial Interests, Institutional, Full or part-time Employment: Gilead Sciences; Financial Interests, Institutional, Stocks/Shares: Gilead Sciences.