First-line immune checkpoint inhibitor use in cisplatin-eligible patients with advanced urothelial carcinoma: a secular trend analysis
Abstract
Aim: Standard first-line treatment of advanced urothelial cell carcinoma involves cisplatin-based chemotherapy, with carboplatin or immune checkpoint inhibitor therapy (ICI) reserved for cisplatin-ineligible individuals. Methods: Using a large de-identified electronic health record-derived database of patients with advanced urothelial cell carcinoma in the USA, we examined trends in utilization of first-line systemic therapies in cisplatin-eligible patients from 1 January 2015 to 31 March 2018. Results: Among 1181 cisplatin-eligible patients, the quarterly proportion who received first-line ICI increased from 1 to 42% (ptrend <0.001), while the proportion who received cisplatin-based chemotherapy decreased from 53 to 33% (ptrend = 0.018). Patients receiving ICI were older than those receiving cisplatin (median age: 75 vs 68). Conclusion: Our analysis suggests rising off-label ICI use in cisplatin-eligible individuals, potentially because of ICI’s favorable toxicity profile.
References
- 1. Treatment of patients with metastatic urothelial cancer “unfit” for cisplatin-based chemotherapy. J. Clin. Oncol. 29(17), 2432–2438 (2011).
- 2. A consensus definition of patients with metastatic urothelial carcinoma who are unfit for cisplatin-based chemotherapy. Lancet Oncol. 12(3), 211–214 (2011).
- 3. Atezolizumab as first-line therapy in cisplatin-ineligible patients with locally advanced and metastatic urothelial carcinoma: a single-arm, multicentre, Phase II trial. Lancet 389(10064), 67–76 (2017).
- 4. First-line pembrolizumab in cisplatin-ineligible patients with locally advanced and unresectable or metastatic urothelial cancer (KEYNOTE-052): a multicentre, single-arm, Phase II study. Lancet Oncol. 18(11), 1483–1492 (2017).
- 5. . Off-label use of anticancer drugs. Lancet Oncol. 9(11), 1102–1107 (2008).
- 6. US FDA Center for Drug Evaluation and Research. Drug safety and availability – FDA alerts health care professionals and oncology clinical investigators about an efficacy issue identified in clinical trials for some patients taking keytruda (pembrolizumab) or tecentriq (atezolizumab) as monotherapy to treat urothelial cancer with low expression of PD-L1. www.fda.gov/Drugs/DrugSafety/ucm608075.htm
- 7. European Medicines Agency. EMA restricts use of Keytruda and Tecentriq in bladder cancer (2018). www.ema.europa.eu/en/news/ema-restricts-use-keytruda-tecentriq-bladder-cancer
- 8. Flatiron Health Database. Flatiron health database (2018). https://flatiron.com/real-world-evidence/
- 9. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in Renal Disease Study Group. Ann. Intern. Med. 130(6), 461–470 (1999).
- 10. . NCCN clinical practice guidelines in oncology: bladder cancer (2018). www.nccn.org/professionals/physician_gls/PDF/bladder.pdf
- 11. . A Wilcoxon-type test for trend. Stat. Med. 4(1), 87–90 (1985).