2019 ASCO Annual Meeting!
Session: Genitourinary (Nonprostate) Cancer
Type: Poster Session
Time: Monday June 3, 1:15 PM to 4:15 PM
Location: Hall A
Treatment (tx) characteristics of patients (pts) with locally advanced or metastatic urothelial cancer (mUC) receiving checkpoint inhibitor (CPI) monotherapy in a US clinical practice.
Genitourinary (Nonprostate) Cancer
2019 ASCO Annual Meeting
Poster Board Number:
Poster Session (Board #352)
J Clin Oncol 37, 2019 (suppl; abstr 4526)
Author(s): Alicia K. Morgans, Osama E. Rahma, Shivani K. Mhatre, Ching-Yi Chuo, Jessica Davies, Jorge Martinalbo, Nicole N. Davarpanah, Russell Pachynski; Northwestern University, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Genentech, Inc., South San Francisco, CA; Roche Products, Ltd., Welwyn Garden City, United Kingdom; F. Hoffmann-La Roche, Ltd, Basel, Switzerland; Division of Oncology, Washington University Medical School, St. Louis, MO
Background: Approval of anti–PD-L1/anti–PD-1 CPI agents has changed the mUC tx landscape, but real-world (RW) tx patterns are not well described. Here, we describe pt characteristics, time on tx (TOT), tx-cycle distribution, relative dose intensity (RDI) and subsequent tx for pts receiving atezolizumab (atezo), nivolumab (nivo) or pembrolizumab (pembro) monotherapy. Methods: Pts diagnosed with mUC who completed atezo, nivo or pembro in the first-line (1L) or prior-platinum second-line and beyond (2L+) settings by April 30, 2018, were identified from the US-based Flatiron Health electronic health record–derived database. TOT was defined as time from first to last CPI administration + 1 cycle, tx cycles as number of CPI doses received during TOT and RDI as ratio of actual to planned dose per week to reflect any dose interruption. Results: RW data from pts receiving atezo, nivo and pembro were analyzed (Table). Up to 38% of pts had ECOG PS > 1. Median TOT ranged from 2.1-2.8 mo, with overlapping 95% CIs; mean TOT ranged from 2.7-4.1 mo. Over 50% of pts had ≤ 4 tx cycles. 21%-38% of pts did not have RDI within 95%-105% of the labeled dose. Most common subsequent txs were platinum-based chemotherapy combinations with gemcitabine or taxanes (post–1L CPI) and taxane monotherapy or other CPI monotherapy/combinations (post–2L+ CPI). Conclusions: Here, we present the largest analysis of RW CPI use in mUC to date. Overall, this unadjusted descriptive analysis showed relative comparability of pt and tx characteristics and TOT across CPI-treated groups. Insights into RW tx allow for an understanding of how clinical trial data translate to broader pt populations, including those with ECOG PS > 1, and may be useful for practitioners.
|Atezo, 1La||Atezo, 2L+||Nivo, 2L+||Pembro, 1La||Pembro, 2L+|
|≥ 65 years, %||86||84||69||88||78|
|ECOG PS > 1, %b||38||19||6||33||20|
|Median TOT, mo (95% CI)||2.1 (0.7, 4.2)||2.8 (1.4, 4.9)||2.0 (1.2, 3.6)||2.8 (1.4, 3.8)||2.7 (1.4, 3.5)|
|Mean TOT, mo (SD)||2.9 (2.9)||4.0 (3.8)||2.7 (2.1)||2.9 (1.9)||2.9 (1.8)|
|> 4 tx cycles, %||35||43||49||41||30|
|95%-105% RDI, %||76||79||62||68||70|
a Unknown cisplatin eligibility and prior (neo)adjuvant platinum use. b % based on pts with known ECOG PS.
1. CALGB 90601 (Alliance): Randomized, double-blind, placebo-controlled phase III trial comparing gemcitabine and cisplatin with bevacizumab or placebo in patients with metastatic urothelial carcinoma.