Impact of treatment patterns and sequencing on clinical and economic outcomes in patients with metastatic urothelial cancer: IMPACT UC II study.

IF 4.2 2区医学 Q1 ONCOLOGY

Oncologist Pub Date : 2025-10-01 DOI:10.1093/oncolo/oyaf249

Mehmet A Bilen, Brandon Diessner, John White, Louise Murphy, Amy Nguyen, Melissa Kirker, Norbek Gharibian, Valerie Morris, Abhijeet Bhanegaonkar

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引用次数: 0

Abstract

Importance: Real-world data about treatment sequencing and economic and clinical outcomes in patients with metastatic urothelial cancer (mUC) are limited.

Objective: The IMPACT UC II study evaluated real-world overall survival (OS), first-line (1L) to second-line (2L) progression, and healthcare resource utilization (HCRU) and costs in patients with mUC before US approval of avelumab 1L maintenance in June 2020.

Design: Retrospective study.

Setting: US insurance claims data from the Optum Research Database.

Participants: Adults diagnosed with mUC from July 2015 to June 2020, observed until death, disenrollment, or study end (August 2021).

Intervention(s) or exposure(s): Three cohorts were defined based on 1L treatment received: cisplatin-based chemotherapy, carboplatin-based chemotherapy, or immuno-oncology (IO) monotherapy.

Main outcome(s) and measure(s): Analyses included OS (multivariable Cox proportional hazards),1L-to-2L progression (incidence rates), HCRU and costs (medians), and multivariable-adjusted cumulative 24-month predicted costs (Lin regression models).

Results: Of 3006 patients with mUC, 1037 received 1L treatment: cisplatin-based in 365 (35.2%), carboplatin-based in 337 (32.5%), and IO in 335 (32.3%). Compared with 1L cisplatin-based chemotherapy, mortality risk (hazard ratio [95% CI]) was doubled with IO monotherapy (2.0 [1.6-2.5]) and 1.5-times higher with carboplatin-based chemotherapy (1.5 [1.3-1.9]). The 1L-to-2L progression rate per 100 person-years was highest in patients receiving carboplatin-based chemotherapy (74.4) compared with cisplatin-based chemotherapy (51.9) and IO monotherapy (29.8). All-cause HCRU was lowest with carboplatin-based chemotherapy. Median all-cause and mUC-related costs were highest with IO monotherapy (mUC-related per patient per month: IO, $9739; cisplatin-based, $6687; carboplatin-based, $5219) as were cumulative 24-month predicted costs (mUC-related: IO, $157 595; cisplatin-based $122 351; carboplatin-based, $112 412).

Conclusions: Approximately one-third of patients with mUC in this population received 1L therapy. Mortality, HCRU, and costs were higher with IO monotherapy vs platinum-based chemotherapy.

Relevance: Results provide baseline data for future studies evaluating the impact of newer treatment options for patients with mUC.

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治疗模式和排序对转移性尿路上皮癌患者临床和经济结果的影响：Impact UC II研究

背景：IMPACT UC II研究评估了转移性尿路上皮癌（mUC）患者在2020年6月美国批准avelumab 1l维持之前的真实世界总生存期（OS）、一线（1l）至二线（2l）进展、医疗资源利用（HCRU）和成本。患者和方法：回顾性分析2015年7月至2020年6月诊断为mUC的成人的索赔数据，分为三个1 L队列：以顺铂为基础的化疗，以卡铂为基础的化疗和免疫肿瘤（IO）单一治疗。观察患者从mUC诊断到死亡、退组或研究结束（2021年8月）。分析包括OS（多变量Cox比例风险）、1l - 2l进展（发病率）、HCRU和成本（中位数），以及多变量调整后的24个月累积预测成本（Lin回归模型）。结果：在3006例mUC患者中，1037例接受了1 L治疗：以顺铂为基础的365例（35.2%），卡铂为基础的337例（32.5%），IO为335例（32.3%）。与1 L顺铂为基础的化疗相比，IO单药治疗的死亡风险（危险比[95% CI]）增加了一倍（2.0[1.6-2.5]），卡铂为基础的化疗的死亡风险增加了1.5倍（1.5[1.3-1.9]）。每100人年1 l到2l的进展率在接受卡铂化疗的患者中最高（74.4），而接受顺铂化疗的患者（51.9）和IO单药治疗的患者（29.8）。全因HCRU以卡铂为基础的化疗最低。IO单药治疗的全因和mucc相关费用中位数最高(每个患者每月与mucc相关：IO， 9739美元；cisplatin-based, 6687美元;基于卡铂的药物，5219美元)，以及24个月的累积预测成本(与药物相关：IO， 157,595美元；cisplatin-based 122351美元;carboplatin-based, 112412美元)。结论：该人群中大约三分之一的mUC患者接受了1l治疗。与以铂为基础的化疗相比，IO单药治疗的死亡率、HCRU和费用更高。

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来源期刊

Oncologist 医学-肿瘤学

CiteScore

10.40

自引率

3.40%

发文量

309

审稿时长

3-8 weeks

期刊介绍： The Oncologist® is dedicated to translating the latest research developments into the best multidimensional care for cancer patients. Thus, The Oncologist is committed to helping physicians excel in this ever-expanding environment through the publication of timely reviews, original studies, and commentaries on important developments. We believe that the practice of oncology requires both an understanding of a range of disciplines encompassing basic science related to cancer, translational research, and clinical practice, but also the socioeconomic and psychosocial factors that determine access to care and quality of life and function following cancer treatment.