Treatment patterns and outcomes in “real world” patients (pts) with metastatic urothelial cancer (UC).

Genitourinary (Nonprostate) Cancer
Session Type and Session Title: 
Poster Discussion Session, Genitourinary (Nonprostate) Cancer
Abstract Number: 
J Clin Oncol 31, 2013 (suppl; abstr 4525)
Matt D. Galsky, Simon Chowdhury, Joaquim Bellmunt, Yu-Ning Wong, Federica Recine, Sumanta Kumar Pal, Erin L. Moshier, Sylvain Ladoire, Ugo De Giorgi, Evan Y. Yu, Guenter Niegisch, Simon J. Crabb, Mabel A Mardones, Andrea Necchi, Ali Reza Golshayan, Aristotelis Bamias, Roy Mano, Lauren Christine Harshman, Thomas Powles, Jonathan E. Rosenberg, RISC Investigators; Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; University Hospital del Mar, Barcelona, Spain; Fox Chase Cancer Center, Philadelphia, PA; San Camillo-Forlanini Hospital, Rome, Italy; City of Hope, Duarte, CA; Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Georges-François Leclerc Cancer Center, Dijon, France; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy; Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Urology, Heinrich-Heine-University, Duesseldorf, Germany; University of Southampton, Faculty of Medicine, Southampton, United Kingdom; Hunstman Cancer Institute, Salt Lake City, UT; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Medical University of South Carolina, Charleston, SC; HECOG and University of Athens, Athens, Greece; Rabin Medical Center, Tel Aviv, Israel; Dana-Farber Cancer Institute, Boston, MA; Barts and the London, London, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY

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Abstract Disclosures


Background: Most studies reporting outcomes of pts with metastatic UC are derived from clinical trial data, potentially limiting the breadth/generalizability of the findings. To explore patterns of care/outcomes in “real world” pts, we initiated an international retrospective cohort study. Methods: Data were collected via an electronic data capture platform from 23 centers. Eligible pts had UC (at least muscle-invasive) and were initially evaluated from 1/1/2006-1/1/2011. Parameters were subjected to regression analysis to identify prognostic variables. Results: By 12/18/12, 1905 pts were enrolled. Among 1077 with metastatic UC, median age was 67 (IQR 60-75), 80% were male, 87% had bladder primary tumors, and 33% received perioperative chemotherapy. Only 758 (70%) received 1st-line chemotherapy for metastatic UC: cisplatin-based (51%), carboplatin-based (29%), non-platinum single-agent (16%), and non-platinum multi-agent (4%). The median survival from date of diagnosis of metastatic UC was 5.2 months (95% CI 4.4-6.5) and 16.1 months (95% CI 15.1-17.5) for pts who did and did not receive 1st-line chemotherapy, respectively [13.9 months (95% CI 12.78-14.98) from start of chemotherapy for latter group]. Among pts receiving 1st-line chemotherapy, univariable analysis revealed gender, primary tumor site, removal of primary, creatinine clearance, LDH, and hgb were not significantly associated with survival whereas smoking status, performance status, perioperative chemotherapy, metastatic sites, study site and chemotherapy regimen were. The multivariable analysis is shown in the Table. Conclusions: The current analysis identifies previously unrecognized prognostic factors in an international cohort of “real world” pts with metastatic UC treated with 1st-line chemotherapy. A large subset of pts with metastatic UC receives no chemotherapy.

Prognostic factors for survival in pts receiving 1st-line chemotherapy.
HR 95% CI P
Smoking history Current vs. never/former 1.48 1.12-1.95 0.006
Perioperative chemotherapy No vs. yes 0.63 0.46-0.86 0.004
# of visceral metastatic sites 1 vs. 0 1.76 1.25-2.47 0.001
≥2 vs. 0 2.23 1.56-3.20 <0.001
ECOG PS 1 vs. 0 1.73 1.29-2.32 <0.001
≥2 vs. 0 2.98 2.02-4.40 <0.001