The treatment landscape for metastatic urothelial carcinoma (mUC) has rapidly evolved with immune checkpoint inhibitors (ICI), FGFR-targeted therapies, antibody-drug conjugates, and more recently first-line enfortumab vedotin (EV) plus pembrolizumab.
In many countries, this combination is not yet available, and the standard of care (SOC) remains platinum-based chemotherapy (PBC) followed by ICI. Real-world data on treatment sequencing and attrition across therapy lines in unselected populations are limited.
We analyzed patients with mUC treated between January 2020 and December 2023 across 4 French oncology centers. Eligible patients had received at least 1 cycle of PBC. Overall survival (OS), treatment sequences, and attrition rates were assessed. Survival was estimated using Kaplan-Meier methods.
A total of 180 patients were included (median age 72 years; 81% male; 84% urothelial carcinoma). All received first-line PBC; 127 (71%) were non-progressive and eligible for avelumab maintenance, but 24 (19%) did not receive it. Only 54 patients (64%) received second-line therapy, and 45 (25%) reached third-line treatment. Median OS was 22.4 months (95% CI: 17.2-26.7). Patients receiving PBC followed by avelumab maintenance achieved a median OS of 29.0 months, compared with 15.6 months for not reponsders PBC patients. Patients with ECOG 2 to 3 (n = 36) had poor outcomes (median OS 7.2 months vs. 26.4 months for ECOG 0-1; P < 0.001).
This study confirms the real-world effectiveness of contemporary treatment sequences, highlights significant attrition between therapy lines, and underscores the need for upfront use of effective agents, particularly in patients with poor performans status.
Urologic oncology. 2026 Feb 28 [Epub ahead of print]
Fabien Moinard-Butot, Jean-Baptiste Barbe-Richaud, Edwige Baudry, Laure Pierard, Karim Amrane, Denis Maillet, Philippe Barthélémy
Department of Medical Oncology, University Hospital of Strasbourg, Strasbourg, France. Electronic address: ., Department of Medical Oncology, University Hospital of Strasbourg, Strasbourg, France., Department of Medical Oncology, Institut de cancérologie de Lorraine, Nancy, France., Department of Medical Oncology, Centre Hospitalier Morlaix, France., Medical Oncology Department, Hospices civils de lyon, Pierre-Bénite, France.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41764970