Several immune checkpoint inhibitor therapies (CPIs) have been approved to treat
metastatic urothelial cell carcinoma (mUC). Because of the favorable toxicity profile of CPI
compared with chemotherapy, oncologists may have a low threshold to prescribe CPI to
patients near the end of life. We evaluated trends in initiation of end‐of‐life systemic therapy
in 1,637 individuals in the Flatiron Health Database who were diagnosed with mUC
between 2015 and 2017 and who died. Rates of systemic therapy initiation in the last 30 and …

395 Background: National guidelines recommend against chemotherapy use at the end of
life. Five CPIs are now approved for aUC. We hypothesized that oncologists may have a
lower threshold to initiate CPI in patients (pts) at the end of life, particularly among pts with
poor performance status (PS), because of the perceived favorable toxicity profile of CPI.
Methods: We conducted a secular trend analysis using the Flatiron Health Database, a large
real-world electronic medical record-derived dataset. We used nonparametric tests of trend …