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- Title
Evaluating Oncologists' Practice Patterns and Decision-Making in Locally Advanced or Metastatic Urothelial Carcinoma: The US Physician PARADIGM Study.
- Authors
Gupta, Shilpa; Costantino, Halley; Ike, Chiemeka; Gupta, Shaloo; Bhanegaonkar, Abhijeet; Su, Cathy; Thakkar, Sheena; Mackie, deMauri S; Devgan, Geeta; Katzenstein, Howard M; Liu, Frank X
- Abstract
Background The treatment landscape for locally advanced/metastatic urothelial carcinoma (la/mUC) has evolved. This study examined US prescribing patterns and clinical decision-making for first-line (1L) and first-line maintenance (1LM) treatment. Materials and Methods US-based oncologists (N = 150) completed an online survey on patient demographics, practice patterns, and important factors considered in 1L/1LM selection. Multivariable logistic regression was used to assess factors associated with more vs less frequent 1L/1LM prescribing. Results Physician reports estimated that 23% of patients with la/mUC had not received any systemic therapy in the previous 6 months; however, 46% received 1L, 32% received second-line, and 22% received subsequent-line systemic treatments. Of patients who were receiving 1L treatment, 72% were estimated to be receiving 1L platinum-based chemotherapy. Around 69% of patients eligible for 1LM received the treatment. Physicians categorized as frequent prescribers reported overall survival (OS), disease control rate (DCR), and rate of grade 3/4 adverse events (AEs) as factors associated with 1L treatment selection (all P < .05). OS, rate of grade 3/4 immune-mediated AEs, and inclusion in institutional guidelines were reported as attributes used in 1LM treatment selection (all P < .05). Multivariable analysis revealed OS, DCR, and rate of grade 3/4 AEs as important factors in oncologists' 1L treatment selection; academic practice setting and use of Response Evaluation Criteria in Solid Tumors version 1.1 were associated with 1LM use (all P < .05). Conclusion OS and AEs were found to be relevant factors associated with offering 1L and 1LM treatment. Variability exists in physicians' decision-making in the real-world setting for la/mUC.
- Subjects
UNITED States; BLADDER tumors; IMMUNE checkpoint inhibitors; MULTIVARIATE analysis; CANCER chemotherapy; CROSS-sectional method; METASTASIS; INTERVIEWING; TRANSITIONAL cell carcinoma; SURVEYS; PLATINUM; QUALITATIVE research; QUESTIONNAIRES; RESEARCH funding; PHYSICIAN practice patterns; DECISION making in clinical medicine; LOGISTIC regression analysis; ONCOLOGISTS; OVERALL survival
- Publication
Oncologist, 2024, Vol 29, Issue 3, p244
- ISSN
1083-7159
- Publication type
Article
- DOI
10.1093/oncolo/oyad267