Treatment patterns and clinical outcomes in metastatic urothelial carcinoma: a German retrospective real-world analysis
Creators: name: Niegisch, Günter
name: Grimm, Marc-Oliver
name: Hardtstock, Fraence
name: Krieger, Julia
name: Starry, Alexandra
name: Osowski, Ulrike
name: Guenther, Silke
name: Deiters, Barthold
name: Maywald, Ulf
name: Wilke, Thomas
name: Kearney, Mairead
Publisher: name: Taylor & Francis
Year: 2024
Subjects: subject: Medicine
subject: Cell Biology
subject: Pharmacology
subject: Biotechnology
subject: Chemical Sciences not elsewhere classified
subject: Immunology
subject: FOS: Clinical medicine
subject: Cancer
subject: Science Policy
subject: Infectious Diseases
subject: FOS: Health sciences
subject: Virology
subject: Computational Biology

description: <b>Aim:</b> This study assessed real-world treatment in patients with metastatic urothelial carcinoma (mUC) in Germany. <b>Materials &amp; methods:</b> Patients diagnosed with mUC from 2015 to 2019 were identified in two claims databases: AOK PLUS and GWQ. <b>Results:</b> 3226 patients with mUC were analyzed; 1286 (39.9%) received systemic treatment within 12 months of diagnosis (platinum-based chemotherapy: 64.2%). Factors associated with receiving treatment were: younger age, male sex, less comorbidity and recent diagnosis. In AOK PLUS and GWQ populations, unadjusted median overall survival (interquartile range) from diagnosis in treated patients was 13.7 (6.8–32.9) and 13.8 (7.1–41.7) months, and in untreated patients was 3.0 (1.2–10.8) and 3.6 (1.2–18.8) months, respectively. <b>Conclusion:</b> A significant proportion of patients with mUC in Germany receive no systemic treatment. This article reports the results from a study in Germany between 2015 and 2019 that investigated how advanced bladder cancer that has spread to other organs was treated and how long people lived after diagnosis. The study looked at systemic therapies, which means treatments that affect the entire body. Only 40% of people diagnosed with advanced bladder cancer received systemic treatment within the first 12 months. Of those who did receive systemic treatment, the majority received combination therapy that included a chemotherapy drug containing platinum (64%). Systemic treatment was more likely to be given to people who were younger, less sick, male, or more recently diagnosed. After 12 months, 56% of treated people were still alive, compared with 26% of people without treatment. On average, people who received systemic treatment lived for about 14 months, while people without systemic treatment lived for only 3 to 4 months. Many people with advanced bladder cancer in Germany do not receive systemic treatment. People who receive treatment are likely to live longer than those who do not receive treatment. This study sought to explore real-world treatment rates, treatment patterns, and outcomes in patients with metastatic urothelial carcinoma (mUC) in Germany. Patients in Germany with an incident mUC diagnosis from 2015 to 2019 were identified in two claims databases (AOK PLUS and GWQ) covering ≈8 million patients. Of 3226 patients with mUC identified, 1892 (58.6%) did not receive systemic treatment, 1286 (39.9%) received systemic treatment within the first 12 months after diagnosis and 48 (1.5%) received systemic treatment ≥12 months after diagnosis. Among treated patients, 825 (64.2%) received platinum-based chemotherapy, 322 (25.0%) received non-platinum chemotherapy, and 139 (10.8%) received immunotherapy. Factors associated with a higher likelihood of receiving systemic treatment within 12 months included younger age, lower comorbidity score, more recent diagnosis and male sex. The probability of survival at 12 months after diagnosis in the treated and untreated cohorts was 56.1 and 26.1%. The probability of survival at 12 months after diagnosis for patients receiving platinum-based chemotherapy, non-platinum chemotherapy, or immunotherapy was 60.4, 49.4 and 46.8%, respectively. Unadjusted median OS from diagnosis in the AOK PLUS and GWQ populations in treated patients was 13.7 (interquartile range [IQR], 6.8–32.9) and 13.8 months (IQR, 7.1–41.7) months, and in untreated patients was 3.0 (IQR, 1.2–10.8) months and 3.6 months (IQR, 1.2–18.8), respectively. These findings suggest that a substantial proportion of patients with mUC in Germany remained undertreated during the study period.