Evaluating Oncologists' Practice Patterns and Decision-Making in Locally Advanced or Metastatic Urothelial Carcinoma: The US Physician PARADIGM Study

• Published in: The oncologist (Dayton, Ohio) Vol. 29; no. 3; pp. 244 - 253
• Main Authors: Gupta, Shilpa, Costantino, Halley, Ike, Chiemeka, Gupta, Shaloo, Bhanegaonkar, Abhijeet, Su, Cathy, Thakkar, Sheena, Mackie, deMauri S, Devgan, Geeta, Katzenstein, Howard M, Liu, Frank X
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.03.2024
• Subjects: Analysis; Bladder cancer; Cancer; Carcinoma; Carcinoma, Transitional Cell - drug therapy; Care and treatment; Chemotherapy; Drug therapy; Drugs; Genitourinary Cancer; Humans; Medical research; Medicine, Experimental; Metastasis; Oncologists; Pharmaceutical industry; Physicians; Practice; Prescribing; Prescription writing; Response Evaluation Criteria in Solid Tumors; Surveys; Urinary Bladder Neoplasms - pathology; United States; Germany; immune checkpoint inhibitor; systemic therapy; decision-making; chemotherapy; urinary bladder cancer
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1093/oncolo/oyad267

The treatment landscape for locally advanced/metastatic urothelial carcinoma (la/mUC) has evolved. This study examined US prescribing patterns and clinical decision-making for first-line (1L) and first-line maintenance (1LM) treatment. US-based oncologists (N = 150) completed an online survey on patient demographics, practice patterns, and important factors considered in 1L/1LM selection. Multivariable logistic regression was used to assess factors associated with more vs less frequent 1L/1LM prescribing. Physician reports estimated that 23% of patients with la/mUC had not received any systemic therapy in the previous 6 months; however, 46% received 1L, 32% received second-line, and 22% received subsequent-line systemic treatments. Of patients who were receiving 1L treatment, 72% were estimated to be receiving 1L platinum-based chemotherapy. Around 69% of patients eligible for 1LM received the treatment. Physicians categorized as frequent prescribers reported overall survival (OS), disease control rate (DCR), and rate of grade 3/4 adverse events (AEs) as factors associated with 1L treatment selection (all P < .05). OS, rate of grade 3/4 immune-mediated AEs, and inclusion in institutional guidelines were reported as attributes used in 1LM treatment selection (all P < .05). Multivariable analysis revealed OS, DCR, and rate of grade 3/4 AEs as important factors in oncologists' 1L treatment selection; academic practice setting and use of Response Evaluation Criteria in Solid Tumors version 1.1 were associated with 1LM use (all P < .05). OS and AEs were found to be relevant factors associated with offering 1L and 1LM treatment. Variability exists in physicians' decision-making in the real-world setting for la/mUC.