Real-world treatment patterns for metastatic urothelial cancer in 5 European countries: EVEREST 2

Treatment for locally advanced or metastatic urothelial carcinoma (la/mUC) is evolving in Europe. In 2022, ESMO guidelines recommended avelumab as first-line (1L) maintenance for la/mUC in patients who did not progress on platinum-based chemotherapy (PBC) and, in March 2024, recommended enfortumab vedotin (EV) plus pembrolizumab as the preferred 1L therapy. This study assessed treatment patterns for mUC between December 2023-May 2024.

Data were drawn from the Adelphi Real World mUC Disease Specific Programme™, a cross-sectional survey of physician-reported data across France, Germany, Italy, Spain, and the United Kingdom.

Physicians (n = 238) reported data for 1622 patients. PBC was the predominant 1L treatment, administered to 74% (1201/1622)) of patients, while 20% (326/1622) received nonchemotherapy monotherapy. Overall, 2% (31/1622) of patients received EV at 1L (monotherapy/combination). Avelumab was administered to 10% (160/1622) of patients as 1L therapy, 14% (234/1622) as maintenance, and 3% (55/1622) as second-line (2L) therapy (monotherapy/combination). At data collection, 19% (302/1622) patients had received 2L treatment, of whom 25% (74/302) received EV monotherapy and 21% (63/302) pembrolizumab monotherapy.

Consistent with guidelines, adoption of avelumab maintenance was occurring, although its usage remained limited. Low rates of 2L+ therapies highlight the importance of 1L treatment selection.