Cisplatin Ineligibility for Patients With Metastatic Urothelial Carcinoma: A Survey of Clinical Practice Perspectives Among US Oncologists

BACKGROUND: Cisplatin-based chemotherapy is the first-line (1L) treatment for eligible patients with locally advanced/metastatic urothelial carcinoma (mUC). However, many patients with mUC are ineligible for cisplatin-based therapy due to age- or disease-related factors. Specific criteria used by practicing physicians to determine cisplatin ineligibility have not been well characterized. OBJECTIVE: To understand US oncologists' perspectives and self-reported treatment preferences related to cisplatin-ineligible patients with mUC. METHODS: An electronic survey was administered (November-December 2017) to a random sample from a panel of US oncologists who had agreed to participate in periodic surveys. Eligible participants were required to have >= 2 years of clinical experience, have experience treating >= 5 patients with mUC in the past year, and be board certified and/or eligible. In addition to providing demographic information, clinical preferences, and self-reported practices, participants identified and ranked criteria and reasons for determining cisplatin ineligibility. Descriptive statistics were used to analyze all demographics and responses. RESULTS: From the 301 respondents, the most commonly identified clinical factors for cisplatin ineligibility were renal dysfunction (78%) and poor performance status (77%), followed by neuropathy (47%), solitary kidney (43%), hearing loss (43%), advanced age (43%), and cardiovascular dysfunction (41%). Patients were typically deemed ineligible for cisplatin at diagnosis (58%) or on initiation of 1L metastatic therapy (61%). The preferred non-cisplatin 1L treatments were checkpoint inhibitors (75%), followed by carboplatin-based chemotherapy (19%). CONCLUSIONS: This survey of US oncologists provides insights into clinical perspectives on cisplatin ineligibility in the context of the evolving treatment landscape for patients with mUC.