Immune checkpoint inhibitors (ICI) are commonly used in urothelial carcinoma. We sought to understand provider preferences for subsequent treatment of patients after prior ICI.
We comprised a group of 11 expert genitourinary medical oncologists in the United States and created a survey regarding treatment sequencing.
We present the final responses to this survey, using descriptive statistics.
We received 78 responses (34%) from 227 genitourinary oncologists between May and August 2024; most were practicing for >5 years (62%) and were seeing >25 patients with metastatic urothelial carcinoma (mUC) yearly (72%). For patients with progression while receiving adjuvant ICI, 51% of respondents were somewhat/very likely to use enfortumab vedotin/pembrolizumab (EVP) as next therapy line. For patients with progression after prior ICI, 1/3 of respondents would consider first-line (1L) EVP irrespective of the interval from prior ICI completion. For ICI given in nonmuscle invasive bladder cancer and muscle-invasive bladder cancer, 43% and 45%, respectively would consider EVP > 6 months post-ICI completion. After progression on EVP, 77% were somewhat/very likely to give platinum-based chemotherapy, and most would not include combination or switch maintenance ICI. Similarly, 80% were somewhat/very likely to recommend non-ICI clinical trials in the second-line setting after EVP, and 87% were somewhat/very likely to offer erdafitinib for susceptible FGFR3 alterations.
Survey-based opinions can effectively capture treatment selection preferences for mUC and could inform future clinical trial design. Additional data, including the impact of residual toxicity from 1L EVP, are needed to better understand real-world treatment sequencing patterns.
Clinical genitourinary cancer. 2025 Dec 20 [Epub ahead of print]
Karine Tawagi, Ali R Khaki, Priyanka V Chablani, Jeannie Hoffman-Censits, Vadim S Koshkin, Elizabeth R Plimack, Matt D Galsky, Shilpa Gupta, Jonathan E Rosenberg, Petros Grivas, Peter H O'Donnell
University of Illinois Cancer Center, Chicago, IL. Electronic address: ., Division of Oncology, Stanford University School of Medicine, Stanford, CA., Division of Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA., The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD., Department of Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY., Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH., Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA., Fox Chase Cancer Center, Philadelphia, PA., Memorial Sloan Kettering Cancer Center, New York, NY., University of Washington and Fred Hutchinson Cancer Center, Seattle, WA., University of Chicago Comprehensive Cancer Center, Chicago, IL.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41582039