Evaluation of provider preferences in first-line metastatic cisplatin-ineligible urothelial carcinoma in the setting of platinum shortages

• Published in: Journal of clinical oncology Vol. 42; no. 4_suppl; p. 576
• Main Authors: Weinfeld, Michael Seth, Chablani, Priyanka Vinod, Reizine, Natalie Marie, Stadler, Walter Michael, Tawagi, Karine
• Format: Journal Article
• Language: English
• Published: 01.02.2024
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2024.42.4_suppl.576

576 Background: Standard of care for patients with metastatic urothelial carcinoma (mUC) who are ineligible to receive cisplatin has been gemcitabine and carboplatin (gem/carbo), and more recently followed by maintenance therapy with avelumab. Combination pembrolizumab (pembro) and the antibody-drug conjugate enfortumab vedotin (EV) has shown very promising results and is now approved for first-line therapy in cisplatin-ineligible patients based on the phase Ib/II EV-103 trial. We were interested in assessing providers’ decision-making between gem/carbo and EV/pembro based on perceived comparative response rates and toxicity profiles, as well as the nationwide platinum chemotherapy shortage in 2023. Methods: We sent a 10-question encrypted electronic survey centered on a scenario of a mUC case to 150 oncologists via email listservs and social media. Results: We received 45 responses: 7 oncologists (15.6%) chose gem/carbo, 15 (33.3%) chose EV/pembro, and a majority, 23 (51.5%) chose to discuss both options with patients. 40 (88.9%) were academic or disease focused and 5 (11.1%) described their practice as general oncology. Of oncologists who chose gem/carbo, the most common reasons were: gem/carbo has more long-term data (86.6%) and lack of phase 3 data for EV/pembro (71.4%). Of oncologists who chose EV/pembro, the most common reasons were: higher response rates (86.7%) followed by the carboplatin shortage (40%). Only 6.7% chose the carboplatin shortage as the main reason while 73.3% chose higher response rates as the main reason. Of oncologists who chose to discuss both, the most common reasons why they would consider EV/pembro were: higher response rates (82.6%), followed by patient preference (56.5%), followed by the carboplatin shortage (43.5%). 60.9% chose higher response rates as the main reason why they would consider EV/pembro. Conclusions: This questionnaire-based study of predominantly academic genitourinary oncologists suggests that the majority would consider EV/pembro as a first-line treatment for cisplatin-ineligible patients with mUC. The primary reason for this choice was the belief that it has higher response rates, as opposed to the national shortage of carboplatin or concerns regarding toxicity. We anticipate that the awaited results of the EV-302 trial in the coming months will also change the treatment landscape of mUC. However, similar issues may be relevant in the future for other treatment decisions in which incomplete information is available or with ongoing chemotherapy shortages.