Preferred Treatment Sequencing for Metastatic Urothelial Carcinoma (mUC) in the Era of Perioperative and First-Line (1L) Checkpoint Inhibitor: Results From a National Survey of Genitourinary Oncologists.

BACKGROUND

Immune checkpoint inhibitors (ICI) are commonly used in urothelial carcinoma. We sought to understand provider preferences for subsequent treatment of patients after prior ICI.

MATERIALS AND

METHODS

We comprised a group of 11 expert genitourinary medical oncologists in the United States and created a survey regarding treatment sequencing. We present the final responses to this survey, using descriptive statistics.

RESULTS

We received 78 responses (34%) from 227 genitourinary oncologists between May and August 2024; most were practicing for >5 years (62%) and were seeing >25 patients with metastatic urothelial carcinoma (mUC) yearly (72%). For patients with progression while receiving adjuvant ICI, 51% of respondents were somewhat/very likely to use enfortumab vedotin/pembrolizumab (EVP) as next therapy line. For patients with progression after prior ICI, 1/3 of respondents would consider first-line (1L) EVP irrespective of the interval from prior ICI completion. For ICI given in nonmuscle invasive bladder cancer and muscle-invasive bladder cancer, 43% and 45%, respectively would consider EVP > 6 months post-ICI completion. After progression on EVP, 77% were somewhat/very likely to give platinum-based chemotherapy, and most would not include combination or switch maintenance ICI. Similarly, 80% were somewhat/very likely to recommend non-ICI clinical trials in the second-line setting after EVP, and 87% were somewhat/very likely to offer erdafitinib for susceptible FGFR3 alterations.

CONCLUSION

Survey-based opinions can effectively capture treatment selection preferences for mUC and could inform future clinical trial design. Additional data, including the impact of residual toxicity from 1L EVP, are needed to better understand real-world treatment sequencing patterns.