Klein A, Parikh R, Kurosky S, Esterberg E, Kaye JA. Clinical characteristics, treatment patterns, and healthcare resource utilization in patients with advanced urothelial carcinoma after progression on platinum-based therapy: a medical record review study in the United States and Canada. Poster presented at the 2019 ISPOR 24th Annual International Meeting; May 20, 2019. New Orleans, LA.

OBJECTIVE: To describe real-world clinical characteristics, treatment patterns, and health care resource utilization in patients diagnosed with inoperable locally advanced or metastatic urothelial carcinoma (advanced UC) whose disease progressed following platinum-based chemotherapy in the United States (US) and Canada.

METHODS: We conducted a retrospective review of medical records of patients diagnosed with advanced UC in the US and Canada. Eligible patients were aged ≥ 18 years and experienced disease progression after receipt of platinum-based therapy between January 1, 2011, and March 31, 2016. The date of disease progression defined the index date.

Among 201 patients in the US and 63 patients in Canada, 76.6% (US) and 79.4% (Canada) were male, and 71.6% (US) and 93.7% (Canada) were white. The median age was 63.3 (US) and 66.8 (Canada) years, and 53.2% (US) and 49.2% (Canada) had a performance status of 0/1. In the US and Canada, most patients were initially diagnosed with stage 3 UC (73.1% and 81.0%, respectively), and most primary tumors were in the urinary bladder (86.6% and 90.5%, respectively). At initial diagnosis, 13 (6.5%, US) and 2 (3.2%, Canada) patients were tested for tumor programmed cell death ligand-1 (PD-L1) expression. The most frequently administered first-line platinum-based regimen was cisplatin with gemcitabine (37.8%, US; 52.4%, Canada). After the index date, 86.6% (US) and 61.9% (Canada) of patients received further systemic therapy. The most common second-line treatments were single-agent gemcitabine (12.6%, US), pemetrexed (12.6%, US), and paclitaxel (51.3%, Canada). Patients with documented healthcare utilization during second-line treatment (70.7%, US; 59.0%, Canada) had a median of 1.2 UC-related encounters per month in the US and 0.8 encounters in Canada.

CONCLUSIONS: After disease progression, patients typically received single agents and the preferred drug differed by country. PD-L1 testing was uncommon, plausibly because patients in this study were diagnosed before the approval of anti-PD-1/PD-L1 agents for UC.

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