Treatment Patterns and Use of Immune Checkpoint Inhibitors Among Patients with Metastatic Bladder Cancer in a Dutch Nationwide Cohort

Anke Richters; Debbie G J Robbrecht; Richard P Meijer; Antoine G van der Heijden; Lambertus A L M Kiemeney; Joan van den Bosch; Britt B M Suelmann; Berna C Özdemir; ProBCI Study Group; Niven Mehra; Katja K H Aben

doi:10.1016/j.euros.2023.11.010

Treatment Patterns and Use of Immune Checkpoint Inhibitors Among Patients with Metastatic Bladder Cancer in a Dutch Nationwide Cohort

Eur Urol Open Sci. 2023 Dec 20:59:50-54. doi: 10.1016/j.euros.2023.11.010. eCollection 2024 Jan.

Authors

Affiliations

¹ Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
² Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
³ Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
⁴ Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
⁵ Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
⁶ Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
⁷ Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
⁸ Department of Medical Oncology, Bern University Hospital, Bern, Switzerland.
⁹ Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.

Abstract

Since 2017, two immune checkpoint inhibitors (ICIs) have become the standard of care for the treatment of metastatic urothelial carcinoma in Europe: pembrolizumab as second-line therapy and avelumab as maintenance therapy. Our aim was to describe the use of ICIs as first and later lines of treatment in patients with metastatic bladder cancer (mBC) in the Netherlands. We identified all patients diagnosed with primary mBC between 2018 and 2021 in the Netherlands from the Netherlands Cancer Registry (NCR). NCR data were supplemented with data from the Dutch nationwide Prospective Bladder Cancer Infrastructure (ProBCI) collected from medical files, with follow-up until death or end of data collection on January 1, 2023. A total of 1525 patients were diagnosed with primary mBC between 2018 and 2021 in the Netherlands. Of these, 34.7% received at least one line of systemic treatment with chemotherapy or ICI. After first-line platinum-based chemotherapy, 34.1% received second-line ICI and 3.9% received maintenance ICI. Among patients who completed or discontinued first-line cisplatin- or carboplatin-based chemotherapy after approval of maintenance ICI in the Netherlands, 40.7% and 19.7% received second-line ICI, and 9.3% and 14.1% received maintenance ICI, respectively. ICI use for mBC treatment has not increased considerably since their introduction in 2017. Future research should assess whether the introduction of maintenance avelumab (available since April 2021 in the Netherlands) has led to increases in the proportion of patients with mBC patients receiving systemic treatment and the proportion receiving ICI.

Patient summary: We assessed the rate of immunotherapy use for patients with metastatic bladder cancer in the Netherlands. Since its introduction, immunotherapy has been used in a minority of patients, mostly as second-line treatment after platinum-based chemotherapy.

Keywords: Cohort study; Immune checkpoint inhibitors; Immunotherapy; Metastatic bladder cancer; Urothelial cancer.