Real-World Treatment Patterns, Sequencing, and Outcomes in Patients with Locally Advanced or Metastatic Urothelial Carcinoma Receiving Avelumab First-Line Maintenance in the United States
, Andrew Rava 4, Sonia Kim 4, Haiyan Sun 4, Marley Boyd 4 and Gabriel Gomez Rey 4Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThe authors presented a real-world data coming from a single cohort of patients with locally advanced or metastatic urothelial carcinoma receiving avelumab first-line maintenance. What is important, this is anoninterventional, retrospective, cohort study with a over 10-year inclusion/observation timeframe (figure 1,2). The analysed outcomes shed some light on the novel approaches with sequenced immunotherapy in the urothelial disease. Some minor question marks were listed below:
Please comment the meaning for your analysis the loss of 23% of patients who did not meet the inclusion criteria (the details were specified in the figure 2).
Although the study enrolled either advanced or metastatic patients, ECOG was predominantly 0-1. Please comment if there might have been the influence on survival.
There were 44% cases with unknown initial stage. This may affect further outcomes. Please comment on that.
Although, there is still a debate ongoing, if the PDL-1 positivity (and its definition) is crucial for the success of the therapy, here the authors in table 1 revealed that over 70% of patients were undetermined. Can you comment on that further? (additionally to the lines 355)
Author Response
Please see the attached response grid file named "Flatiron UC-III Tx Patterns Sequencing_Reviewer Response Grid_Final_30Aug24"
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsI congratulate with the authors for this nicely designed study and nicely written manuscript. Tables and figures are clear and well designed. Methods and results well presented. The limitations of the study correctly highlighted at the end of the manuscript.
My advice is to add a cost-analysis in the discussion (and possibly also in results) and a critical evaluation of the benefits/outcoms on patients compared to the cost for healthcare compared to other therapies.
Author Response
Please see the attached response grid file named "Flatiron UC-III Tx Patterns Sequencing_Reviewer Response Grid_Final_30Aug24"
Author Response File: Author Response.pdf
