Treatment for locally advanced or metastatic urothelial carcinoma (la/mUC) is evolving in Europe. In 2022, ESMO guidelines recommended avelumab as first-line (1L) maintenance for la/mUC in patients who did not progress on platinum-based chemotherapy (PBC) and, in March 2024, recommended enfortumab vedotin (EV) plus pembrolizumab as the preferred 1L therapy. This study assessed treatment patterns for mUC between December 2023-May 2024.
Data were drawn from the Adelphi Real World mUC Disease Specific Programme™, a cross-sectional survey of physician-reported data across France, Germany, Italy, Spain, and the United Kingdom.
Physicians (n = 238) reported data for 1622 patients. PBC was the predominant 1L treatment, administered to 74% (1201/1622)) of patients, while 20% (326/1622) received nonchemotherapy monotherapy. Overall, 2% (31/1622) of patients received EV at 1L (monotherapy/combination). Avelumab was administered to 10% (160/1622) of patients as 1L therapy, 14% (234/1622) as maintenance, and 3% (55/1622) as second-line (2L) therapy (monotherapy/combination). At data collection, 19% (302/1622) patients had received 2L treatment, of whom 25% (74/302) received EV monotherapy and 21% (63/302) pembrolizumab monotherapy.
Consistent with guidelines, adoption of avelumab maintenance was occurring, although its usage remained limited. Low rates of 2L+ therapies highlight the importance of 1L treatment selection.
Real-world treatment patterns for metastatic urothelial carcinoma in 5 European countries: EVEREST 2. Locally advanced or metastatic urothelial carcinoma (la/mUC) is a type of bladder cancer that has spread into the muscle layer of the bladder or to other parts of the body. The treatment recommendations for la/mUC have changed in recent years to reflect new evidence and treatment options. In a study that was done previously, researchers found that the most common medicine given to patients as their first treatment was platinum-containing chemotherapy. In 2022, the European Society for Medical Oncology (ESMO) updated its guidelines to recommend avelumab as a treatment that is given after platinum-containing chemotherapy has worked to shrink or control the cancer, known as maintenance therapy. In March 2024, ESMO updated its guidelines again to recommend a treatment using two medicines, enfortumab vedotin with pembrolizumab, as the preferred first treatment. To help understand the use of newer treatment options, this study examined which treatments patients with la/mUC received between December 2023 and May 2024. A total of 238 doctors in France, Germany, Italy, Spain, and the United Kingdom provided information from 1622 patients. During this period, platinum-based chemotherapy was the most common first treatment. As expected, enfortumab vedotin, with or without pembrolizumab, was used by few patients because the recommendations for these two medicines as a first treatment were made near the end of the study period. Avelumab maintenance therapy was used, but at a low rate. A small number of patients received a second or later treatment, highlighting why it is important to choose the first treatment carefully.
Future oncology (London, England). 2026 May 11 [Epub ahead of print]
Maria De Santis, Neil Milloy, Maria Walley, Amber Simpson, Cameron Forshaw, Marthe Vuillet, Torsten Strunz-McKendry, Janet Kim, Marie-Catherine Thomas
Department of Urology, Charité Universitätsmedizin Berlin, Berlin, Germany., Adelphi Real World, Bollington, UK., Astellas Pharma France, Levallois-Perret, France., Astellas Pharma Europe, Addlestone, UK., Astellas Pharma Inc, Northbrook, IL, USA.