Undertreatment in patients with advanced urothelial cancer: systematic literature review and meta-analysis
Abstract
Aim: To assess rates of no systemic treatment (NST), attrition across lines of therapy, and factors influencing treatment selection in patients with locally advanced or metastatic urothelial cancer (la/mUC).
Methods: Systematic literature review to identify real-world studies reporting NST or attrition rates in la/mUC from 2017-2022 (including data reported since 2015).
Results: Of 2439 publications screened, 29 reported NST rates, ranging from 40-74% in eight European-based studies, 14-60% in 12 US-based studies, and 9-63% in nine studies in other locations (meta-analysis estimate, 39%). Factors associated with NST or no second-line therapy included older age, female sex, poor performance status, poor renal function and distant metastases.
Conclusion: A substantial proportion of patients with la/mUC do not receive guideline-recommended treatment.
Keywords: attrition; best supportive care; chemotherapy; immunotherapy; palliative therapy; platinum-based chemotherapy; systemic therapy; treatment decisions; urothelial cancer.