Background: Bladder cancer has a high recurrence and poor survival. No global standard of care exists for second-line (2L) treatment of metastatic urothelial carcinoma (mUC) after platinum-based chemotherapy. This study examines 2L treatment patterns in Europe.
Methods: Data were collected from 252 physicians from five European countries (France, Germany, Italy, Spain, United Kingdom) between February–March 2017. For each physician, patient characteristics and treatment-related data were collected from medical charts of the five most recent patients who completed/stopped 2L mUC treatment. 2L was defined as treatment after progression, recurrence after first-line (1L) treatment, or recurrence with ≤12 months of neoadjuvant/adjuvant treatment. Physicians had to be in practice ≥2 years and treated ≥5 eligible patients during February 2015–March 2017.
Results: Data were collected from 1,214 patients with mUC who were treated with 2L chemotherapy. Median age at 2L treatment initiation was 65 years (range 32‒95); 73% were male. Primary tumor histology was transitional cell (77%), with distant metastasis (70%), and of moderate (47%) or high (34%) bulk. Comorbidities included hypertension (32%), diabetes (19%), and respiratory disease (11%). Most patients received platinum-based combination 1L treatment (88%), of whom 22% later received 2L platinum-based treatment. Overall, 78% (range 71%‒83%) of patients received non–platinum-based 2L regimens, with most treated with taxane monotherapy (47%; range 33%‒71%, P<0.001) or vinflunine monotherapy (35%; range 11%-50%, P<0.001). 2L treatments were selected based on efficacy (63%), patient characteristics (12%), safety (9%), and national/hospital guidelines (9%); this varied by country (P<0.001). After 2L treatment, 29% of patients had a physician-reported complete or partial response. Third-line treatment was documented in 10% of patients.
Conclusions: In Europe, most 2L mUC treatment is non–platinum-based monotherapy, with treatment type varying by country. The primary rationale for 2L treatment choice is effectiveness, as expected. Poor 2L treatment outcomes suggest a high unmet need for these mUC patients.
