Morgans A, Grewal S, Hepp Z, Fuldeore R, Odak S, Macahilig C, Shillington A, Sonpavde G. Clinical and patient-reported outcomes of advanced urothelial carcinoma following discontinuation of pd-1/l1 inhibitor therapy. Clin genitourin cancer. 2022 Aug 5. doi: 10.1016/j.clgc.2022.08.002

INTRODUCTION: The patterns of care and attrition of locally advanced or metastatic urothelial carcinoma (la/mUC) patients eligible for systemic therapy following PD-1/L1 inhibitors are unclear. The objective of this study was to evaluate the clinical characteristics and treatment patterns among patients with la/mUC following discontinuation of first-line (1L) or second-line (2L) PD-1/L1 inhibitor therapy.

METHODS: An ambispective, multisite, chart review study was conducted in the United States, including patients with la/mUC. Eligible patients had initiated and subsequently discontinued PD-1/L1 therapy in the 1L or 2L setting for la/mUC between May 2016–July 2018; with follow-up through October 2019. Patient characteristics, treatments and overall survival (OS) were described. Patients had the option to complete a one-time patient reported outcomes (PRO) survey.

RESULTS: Among 300 patients included in the chart review, 198 (66%) received 1L PD-1/L1 inhibitor and 102 (34%) received 2L PD-1/L1 inhibitor. Following discontinuation of PD-1/L1 inhibitor therapy, 34% (n=68) received subsequent therapy in 2L and 29% (n=30) in third-line (3L). The median OS post-1L PD-1/L1 inhibitor was 9.4 (95% CI 8.6–NA) and 2.5 months (95% CI 2.24–3.50) for those who received and did not receive subsequent therapy, respectively. Following 2L PD-1/L1 inhibitor discontinuation, the median OS was 5.7 (95% CI 5.1–7.8) and 3.98 (95% CI 3.29–4.87) months for those who received and did not receive subsequent therapy, respectively. Among those with PRO data, 64% reported experiencing cancer-related pain and 29.6% received an opioid. Only 12.7% reported having a caregiver, requiring approximately 13 hours/day of service.

CONCLUSIONS: The symptom and caregiver burden are high among real-world patients with la/mUC who discontinued 1L or 2L PD-1/L1 inhibitors and outcomes are dismal, with a minority receiving subsequent therapy. Patterns of care in the setting of 1L maintenance avelumab and novel agents require further investigation.

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