OBJECTIVE: To describe real-world clinical characteristics and treatment patterns among patients diagnosed with advanced (i.e., metastatic or inoperable locally advanced) urothelial carcinoma (UC) in the United States (US), Canada, the United Kingdom (UK), Germany, Spain, and France.
METHODS: We reviewed medical records of patients aged ≥ 18 years diagnosed with advanced UC between January 1, 2011, and March 31, 2016 (i.e., before the approval of anti-programmed cell death protein 1 [PD-1] and anti-programmed cell death ligand 1 agents [PD-L1]). The date of diagnosis of advanced UC defined the index date (start of follow-up).
RESULTS: The sample included 211 (US), 56 (Canada), 199 (UK), 210 (Germany), 204 (Spain), and 106 (France) patients. The majority of patients in each country were white (63.5%-99.5%), male (68.8%-84.0%), and initially diagnosed with stage 3 UC (55.0%-91.0%). The median age ranged from 59.6 years in Germany to 66.5 years in France; most patients in each country (63.5%-81.4%) had a performance status of 0 or 1. Few patients (US: 17, 8.1%; Canada: 0; UK: 2, 1.0%; Germany: 6, 2.9%; Spain: 7, 3.4%; France: 10, 9.4%) were tested for PD-L1 tumor expression at initial diagnosis. Most patients (at least 75.0% in each country) received at least one treatment (US: 203; Canada: 43; UK: 176; Germany: 198; Spain: 198; France: 102) for advanced UC. The most common first-line regimens were carboplatin with gemcitabine in the US (28.1%) and France (36.3%) and cisplatin with gemcitabine in Canada (58.1%), the UK (44.9%), Germany (52.5%), and Spain (54.5%). Patients with documented healthcare utilization attended a median of approximately 1 visit per month during first- and second-line treatment.
CONCLUSIONS: Platinum-doublet regimens were common first-line therapies. Although not as effective as cisplatin and gemcitabine, carboplatin and gemcitabine was relatively more common in the US and France, plausibly because of its preferable safety profile.
