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% (p_trend <0.001), while the proportion who received cisplatin-based chemotherapy decreased from 53 to 33% (p_trend = 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.

Keywords::

• chemotherapy
• European Medicines Agency
• Food and Drug Administration
• immunotherapy
• real-world data
• urothelial cancer

Supplementary data

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Financial & competing interests disclosure

This work was supported by the Conquer Cancer Foundation (to RB Parikh) and National Cancer Institute at the National Institutes of Health (grant number K23-CA187185 to R Mamtani). The funders and the Roche Group had no role in the design, conduct, analysis, interpretation, preparation, review or approval of the manuscript and study. SS Baxi, BJS Adamson, AB Cohen and NJ Meropol report employment at Flatiron Health, Inc., which is an independent subsidiary of the Roche Group and stock ownership in Roche. SS Baxi, AB Cohen and NJ Meropol report equity ownership in Flatiron Health. Roche manufactures atezolizumab. JP Christodouleas reports employment at Elekta, Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Additional information

Funding

This work was supported by the Conquer Cancer Foundation (to RB Parikh) and National Cancer Institute at the National Institutes of Health (grant number K23-CA187185 to R Mamtani). The funders and the Roche Group had no role in the design, conduct, analysis, interpretation, preparation, review or approval of the manuscript and study. SS Baxi, BJS Adamson, AB Cohen and NJ Meropol report employment at Flatiron Health, Inc., which is an independent subsidiary of the Roche Group and stock ownership in Roche. SS Baxi, AB Cohen and NJ Meropol report equity ownership in Flatiron Health. Roche manufactures atezolizumab. JP Christodouleas reports employment at Elekta, Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.