Treatment patterns of metastatic urothelial cancer in the United States.

e16500 Background: Bladder cancer is the sixth most prevalent malignancy in the United States, of which urothelial carcinoma (UC) is the predominant histologic type. The prognosis of metastatic UC (mUC) is generally poor with standard platinum-based chemotherapy (PBC) regimens. With approvals of immunotherapy (IO) and antibody drug conjugates (ADCs) in recent years, the treatment landscape has been evolving substantially. This study aimed to describe current, real-world treatment patterns of mUC. Methods: This retrospective study used de-identified, open and closed administrative claims data from Komodo’s Healthcare Map between 1/1/2016 and 5/31/2023. Adult patients were required to have ≥2 claims for UC diagnosis and ≥2 secondary neoplasm claims (within 30 days before or any time after the first UC claim). In closed claims, patients were required to have continuous enrollment during the 6-month baseline period, whereas patients in open claims were required to have at least the median number of claims among all patients in open claims. Index date was defined as the earliest date of a secondary neoplasm claim following UC diagnosis. Patients were observed until death or end of study, whichever occurred first. Treatment patterns, including duration of treatment (DOT), were evaluated in patients who initiated first line (1L) treatment on or after 1/1/2020. A sensitivity analysis was conducted in closed claims alone. Results: Among 38,557 patients who were diagnosed with mUC, 44% received at least one line of treatment at any time. After removing patients who started 1L before 1/1/2020, 28,576 patients meeting eligibility criteria were included at baseline. Median age was 74 years; 77% patients were male; 38% had diabetes or hyperglycemia at baseline; 67% had de novo mUC. PBC with or without IO maintenance, were the most common 1L treatment regimens (47%). IO (39%) and enfortumab vedotin (EV, 21%) were the dominant regimens in 2L. Sacituzumab govitecan (SG) was predominantly administered in 3L (17%). Median DOT was generally longer in earlier versus later lines for most therapies, including PBC followed by IO maintenance, ADCs, FGFR targeted therapy and EV+Pembrolizumab (P), and were similar for other therapies (Table). Findings were similar in the sensitivity analyses. Conclusions: Novel therapies, such as IO and ADCs, have provided additional treatment options for patients diagnosed with mUC. Future studies with longer follow-up are needed to characterize the shifting treatment paradigm, as EV+P becomes a standard of care in 1L mUC. Table: see text