Shortfall in Knowledge Identified in Factors Used for Personalization of Urothelial Carcinoma Treatment

A shortfall in knowledge in the use of biomarkers and patient-related factors for the personalization of treatment for patients with advanced urothelial carcinoma was identified in the baseline data collected from i3 Health’s continuing medical education (CME)–approved visiting faculty meeting series titled New Thinking, New Strategies in Advanced Urothelial Carcinoma, led by Arjun V. Balar, MD, Associate Professor of Medicine and Director of the Genitourinary Medical Oncology Program at NYU Langone Health.

A total of 347 learners engaged in the activity, of whom 297 completed the activity for credit. The activity was presented at the 67th Society of Government Service Urologists’ Kimbrough Urologic Seminar on January 17, 2020, and the content was available online from January 29, 2020 to January 28, 2021. The majority of the 82 learners at the live meetings were physicians (98%), along with a nurse practitioner (1%), and a physician assistant (1%). Participants in the live meetings had been in practice for an average of 17 years. In their practices, they saw an average of 13 patients with urothelial carcinoma per month. The 266 online learners were mostly registered nurses (81%), followed by nurse practitioners (9%), physicians (6%), individuals who selected “other” for their profession (4%), and a physician assistant (<1%). Online participants had been in practice for an average of 18 years and saw an average of nine patients with urothelial carcinoma each month. Learners were given a pretest prior to beginning the activity and a posttest consisting of the same questions following the activity’s conclusion.

The baseline assessment demonstrated a significant shortfall in knowledge of appropriate treatment choice for urothelial carcinoma based on patient-related factors and tumor biomarkers: only 39% of learners could correctly identify the appropriate first-line treatment for a patient with high programmed death ligand 1 (PD-L1)–expressing metastatic urothelial carcinoma, peripheral neuropathy, and renal impairment; only 39% of learners could correctly identify the appropriate treatment for a patient whose urothelial cancer progresses after systemic treatment and whose molecular testing reveals an activating FGFR3 mutation. More learners (66%) could correctly identify that the addition of atezolizumab to platinum-based chemotherapy would improve the overall survival of a patient with previously untreated urothelial carcinoma compared with platinum-based chemotherapy alone, regardless of the patient’s PD-L1 status.

The learners’ overall performance on the posttest, however, revealed that significant learning took place during the activity with respect to all topics. Nearly 83% of learners now chose pembrolizumab as the appropriate first-line treatment for a patient with comorbidities of peripheral neuropathy and renal impairment; 82% correctly chose erdafitinib for a patient with reoccurring disease and a FGFR3 mutation; and 81% now knew that the addition of atezolizumab to platinum-based chemotherapy as a first-line treatment improves overall survival compared with platinum-based chemotherapy.

Learners’ performance on the pre- and post-activity assessments suggested that their clinical competence improved regarding the choice of treatment for patients with urothelial carcinoma. i3 Health has determined that the multidisciplinary team may benefit from future CME–approved activities that provide further and updated strategies to tailor treatment to individual patients, including recent information on predictive and prognostic biomarkers and the incorporation of immune checkpoint inhibitors into the management of advanced disease.

Upon completion of the activity, 86% of participants felt more confident in treating their patients with urothelial carcinoma, and 85% felt that the material presented would be used to improve the outcomes of their patients. 

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