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Purpose: To evaluate the prevalence and characteristics of different HER2 categories among patients with advanced breast cancer (aBC) and describe treatment patterns and outcomes of those with HER2-low disease., Methods: A retrospective cohort study was conducted via chart review at the Huntsman Cancer Institute, including patients diagnosed with aBC (stages IIIB, IIIC and IV) between 2010 and 2019. All patients with IHC1+ were considered HER2-low unless FISH was positive. Patients with IHC2+ were only classified as HER2-low if a negative FISH was documented. The prevalence and characteristics of each HER2 category were reported. Treatment patterns and survival outcomes of HER2-low patients who received first line treatment in 2017 or later were presented., Results: A total of 240 of 414 patients (58%) with aBC were HER2-low, with the majority of patients (83%) classified as hormone receptor (HR)-positive. In first line, most HR-positive patients received endocrine therapy with chemotherapy for stage IIIB/IIIC (47%) and with CDK4/6 inhibitors for stage IV breast cancer (50%) Most HR-negative patients received chemotherapy alone (92% for stage IIIB/IIIC, 60% for stage IV). In second line, chemotherapy alone was the most common modality (21.4% for HR-positive; 45.5% for HR-negative). Median overall survival was 37.7 months while median progression-free survival from first line was 18.0 months, decreasing to 8.0 months in second line., Conclusion: A substantial proportion of patients previously classified as HER2-negative have low but detectable HER2 expression and may benefit from novel HER2-directed agents, which have demonstrated clinical benefit in this population post-chemotherapy., (© 2024. The Author(s).)

Introduction: Prior discrete choice experiments (DCE) in oncology found that, on average, clinicians rank survival as the most important treatment attribute. We investigate heterogeneity in clinician preferences within the context of first-line treatment for advanced urothelial carcinoma in Spain, France, Italy, Germany, and the UK., Methods: The online DCE included 12 treatment choice tasks, each comparing two hypothetical therapy profiles defined by treatment attributes: grade 3/4 treatment-related adverse events (TRAEs), induction and maintenance administration schedules, progression-free survival, and overall survival (OS). We used a random parameters logit model to estimate attribute relative importance (RI) (0-100%) and generate preference shares for four treatment profiles. Results were stratified by country. Preference heterogeneity was evaluated by latent class analysis., Results: In August and September 2022, 498 clinicians (343 oncologists and 155 urologists) completed the DCE. OS had the strongest influence on clinicians' preferences [RI = 62%; range, 51.6% (Germany) to 63.7% (Spain)] followed by frequency of grade 3/4 TRAEs (RI = 27%). Among treatment profiles, the chemotherapy plus immune checkpoint inhibitor maintenance therapy profile had the largest preference share [51%; range, 38% (Italy) to 56% (UK)]. Four latent classes of clinicians were identified (N = 469), with different treatment profile preferences: survival class (30.1%), trade-off class (22.4%), no strong preference class (40.9%), and aggressive treatment class (6.6%). OS was not the most important attribute for 30.0% of clinicians., Conclusion: While average sample results were consistent with those of prior DCEs, this study found heterogeneity in clinician preferences within and across countries, highlighting the diversity in clinician decision making in oncology., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Aim: To assess physician-reported treatment of metastatic bladder cancer in Japan. Methods: 76 physicians completed the CancerMPact ® survey in July 2020, considering patients treated within 6 months. Results: Physicians treated a mean of 38.1 patients per month. Of cisplatin-eligible and -ineligible patients, 97.6 and 89.3%, respectively, received first-line platinum-based therapy, most commonly cisplatin plus gemcitabine (72.9%) and carboplatin plus gemcitabine (59.7%). 1.6 and 5.6% received first-line immune checkpoint inhibitors, respectively. 48.4 and 45.0%, respectively, progressed and received second-line therapy, most commonly with pembrolizumab (61.7%). Conclusion: In 2020, most patients with metastatic bladder cancer in Japan received first-line platinum-based chemotherapy; however, >50% received no subsequent treatment, highlighting the need for new treatment regimens to improve outcomes and maximize first-line treatment benefits.

Aim: This study assessed physician-reported treatment patterns for metastatic bladder cancer. Materials & methods: A total of 106 USA-based physicians were surveyed in 2020 using the CancerMPact ® online survey. Results: Among cisplatin-eligible patients, 86.1% received first-line (1L) platinum-containing chemotherapy, most commonly cisplatin plus gemcitabine, and 9.8% received immune checkpoint inhibitor monotherapy. Among cisplatin-ineligible patients, 46.5% received 1L platinum-containing chemotherapy, most commonly carboplatin plus gemcitabine and 46.2% received 1L immune checkpoint inhibitor therapy. Approximately 44% of patients who received 1L treatment received second-line (2L) therapy after progression. Conclusion: Platinum-containing chemotherapy was the most widely reported 1L treatment approach. A high proportion of patients received no 2L therapy. Validation in an updated dataset is warranted following the practice-changing approvals of avelumab 1L maintenance and additional 2L options.

Introduction: The global treatment landscape for metastatic urothelial cancer (mUC) is evolving, with the recent approval of several new therapeutics. To enable informed treatment decisions, a need exists to understand both treatment patterns and how physicians determine platinum-based treatment eligibility status. This study investigated physicians' current approaches to first-line (1L) chemotherapy, treatment patterns, and assessment of platinum-based treatment eligibility of patients with mUC in real-world clinical practice., Patients and Methods: Data were derived from the Adelphi mUC Disease Specific Programme™, a large, independent, multinational, cross-sectional survey of physicians and their consulting patients with mUC presenting in a real-world clinical setting, conducted in France, Germany, Italy, Spain, and the United Kingdom between November 2020 and April 2021. Physicians completed record forms for their next 8 consecutively consulting patients (≤3 1L, ≤2 second-line, and ≤3 third-line) with a physician-confirmed diagnosis of mUC, reporting data on demographics, clinical characteristics, eligibility for platinum-based chemotherapy, and treatments received., Results: Overall, 232 physicians provided data for 1922 patients. Renal function impairment (72%), Eastern Cooperative Oncology Group performance status (59%), and age (38%) were the most commonly reported criteria physicians used to determine eligibility for platinum-based chemotherapy. At 1L, 82% of patients received platinum-based chemotherapy (cisplatin, 51%; carboplatin, 31%) and 10% received immune checkpoint inhibitor (ICI) therapy. At second-line, 12% received platinum-based chemotherapy, 63% ICI therapy, and 21% non-platinum-based chemotherapy. At third-line, 4% received platinum-based chemotherapy, 41% best supportive care only, and 36% other non-platinum-based chemotherapy., Conclusions: The results of this real-world study indicate that in accordance with European guidelines, the majority of patients with mUC received standard-of-care 1L platinum-based chemotherapy and use of ICIs was limited. Future research should assess how physicians' perceptions toward determining platinum eligibility status evolve with newer guideline recommendations and the introduction of new therapy options for mUC., Competing Interests: Disclosure M Kirker and J Chang are employees of Pfizer and have stocks/shares in Pfizer. M Kearney is an employee of the healthcare business of Merck KGaA, Darmstadt, Germany, and has stock/shares in Merck KGaA, Darmstadt, Germany, Novartis Pharma, and UCB Biopharma SPRL. N Milloy, R Montgomery, C Kluth, and M Unsworth, who conducted the survey, are employees of Adelphi Real World., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Urothelial carcinoma (UC) is a malignancy of the urothelium that encompasses the renal pelvis, bladder, and urethra. Current treatment guidelines for advanced (ie, locally advanced or metastatic) UC recommend using avelumab maintenance therapy in patients with nonprogressive disease following first-line platinum-based chemotherapy. This study aimed to assess the representativeness of the patient population in the JAVELIN Bladder 100 (JB-100) trial, which examined the efficacy and safety of avelumab first-line maintenance, vs. real-world patients with advanced UC that had not progressed with first-line platinum-based chemotherapy treated between 2015 and 2018 by reviewing demographic and clinical characteristics., Patients and Methods: A medical chart review (MCR) study collected demographics and treatment characteristics for patients with advanced UC in the United States, the United Kingdom, and France. Data were analyzed descriptively for review with data collected from patients enrolled in JB-100., Results: Clinical characteristics were consistent between JB-100 and the MCR. Most patients were male, received 4 to 6 cycles of platinum-based chemotherapy, and had an Eastern Cooperative Oncology Group performance status of 0 or 1. All patients in the MCR had either stable disease or a response with platinum-based chemotherapy (∼75% achieved a complete or partial response). Fewer than half (42.5%) of all patients in the MCR received subsequent therapy., Conclusion: Patient demographics, clinical characteristics, and treatment patterns from a MCR of patients with advanced UC that had not progressed following first-line platinum-based chemotherapy appeared similar to data from patients enrolled in JB-100. Future studies should examine whether real-world outcomes are consistent with findings from JB-100., Gov Identifier: NCT02603432., Competing Interests: Disclosure JB has served in consulting or advisory roles for Astellas Pharma, AstraZeneca/MedImmune, Bristol Myers Squibb, Genentech, Novartis, Pfizer, Pierre Fabre, and the healthcare business of Merck KGaA, Darmstadt, Germany; has received travel and accommodation expenses from Ipsen, Merck & Co, Kenilworth, NJ, and Pfizer; has stock and other ownership interests in Rainier Therapeutics; has received honoraria from UpToDate; has received institutional research funding from Millennium, Pfizer, Sanofi, and the healthcare business of Merck KGaA, Darmstadt, Germany; and is an Editorial Board Member of this journal, but was not involved in the peer-review process nor had access to any information regarding its peer review. JC is an employee of Pfizer and holds stock in Bayer, Bristol Myers Squibb, and Pfizer. MP-K is an employee of Pfizer. JCC is an employee and a stockholder of Pfizer. NC is an employee of, has stock and other ownership interests in, and reports honoraria from Pfizer. EE, AH, and SDC are full-time employees of RTI Health Solutions, an independent nonprofit research organization, which was a paid consultant to Pfizer and the healthcare business of Merck KGaA, Darmstadt, Germany in connection with the research for and development of this manuscript. Their compensation is unconnected to the studies on which they work. MK is an employee of the healthcare business of Merck KGaA, Darmstadt, Germany. MA was an employee of RTI Health Solutions, which was a paid consultant to Pfizer and the healthcare business of Merck KGaA, Darmstadt, Germany in connection with the research for and development of this manuscript, when this study was conducted., (Copyright © 2023. Published by Elsevier Inc.)