Changes in Treatment Patterns and Survival Outcomes Across Therapeutic Eras in Metastatic Urothelial Carcinoma: A Multicenter Real‐World Study
Sadafumi Tomioka, Satoshi Inoue, Rion Kawase, Yuriko Nagasaka, Tomoki Hattori, Noritoshi Shamoto, Fumihiro Ito, Yuri Yuguchi, Hideji Kawanishi, Motohiro Maeda, Kosuke Tochigi, Shusuke Akamatsu, Kenji Zennami,ABSTRACT
Objectives
To evaluate temporal changes in treatment patterns and survival outcomes across therapeutic eras in patients with metastatic urothelial carcinoma.
Methods
This retrospective multicenter real‐world cohort study included 727 patients with metastatic urothelial carcinoma who received first‐line systemic therapy between July 2003 and September 2024. Patients were categorized into three treatment eras according to the initiation date of first‐line systemic therapy: the chemotherapy era (Chemo era), pembrolizumab era (Pembro era), and avelumab era (Ave era). Overall survival was analyzed using the Kaplan–Meier method and compared using the log‐rank test. Cox proportional hazards regression analyses identified independent prognostic factors.
Results
Median overall survival was 12.7, 19.7, and 21.8 months in the Chemo, Pembro, and Ave eras, respectively. Overall survival was significantly shorter in the Chemo era than in the other eras, whereas no significant difference was observed between the Pembro and Ave eras. In multivariable analysis, poor performance status, hypoalbuminemia, elevated neutrophil‐to‐lymphocyte ratio, elevated C‐reactive protein level, and liver, lung, and bone metastasis were independently associated with poorer overall survival. The Pembro and Ave eras were independently associated with prolonged overall survival compared with the Chemo era. Treatment patterns changed over time, with decreasing use of chemotherapy alone and increasing use of pembrolizumab‐, avelumab‐, and enfortumab vedotin‐containing treatment sequences.
Conclusions
In this real‐world cohort, survival outcomes improved across successive therapeutic eras in patients with metastatic urothelial carcinoma. Treatment patterns evolved with the introduction of novel systemic therapies, providing contemporary real‐world evidence of changing treatment practices and outcomes.