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.
RESULTS: 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.
