Applying Real-World Evidence to Maintenance Therapy and Treatment Sequencing

This segment examines how real-world evidence is used to guide maintenance therapy and treatment sequencing in advanced urothelial (bladder) cancer. The discussion starts with the evolving first-line landscape: while 70–80% of patients are candidates for cisplatin and many others for carboplatin, newer options, such as antibody–drug conjugates and immunotherapy combinations, are rapidly entering practice. This creates important questions about how best to integrate and sequence therapies over the course of metastatic disease.

The speakers highlight that clinical trials often exclude patients with significant comorbidities, renal impairment, or poor performance status, yet these patients are common in everyday oncology clinics. Real-world data help bridge this gap by showing how treatments perform outside of controlled trial settings and across varied patient populations. The segment underscores that there is no single “right” sequence; choices depend on what patients have already received, how they tolerated prior therapy, why treatment was stopped, and evolving evidence from both trials and observational studies.