Assessing practice gaps and challenges for immunotherapy integration in treatment of metastatic urothelial carcinoma.

694 Background: The approval of pembrolizumab with enfortumab vedotin in the first-line setting has shifted the treatment paradigm for patients with metastatic urothelial carcinoma (mUC). However, integrating these novel therapies into clinical practice can be challenging for health care providers (HCPs). To better understand real-world challenges and barriers for integrating immunotherapy in routine practice, we surveyed providers across community-based oncology settings. Methods: Between 02/2024 and 04/2024, multidisciplinary (MDT) oncology team members (N = 60) across the US were surveyed to assess providers' current practices and challenges regarding biomarker testing, immunotherapy use, and multidisciplinary coordination in mUC care. Teams then participated in a network-wide workshop to develop action plans for improving mUC care. Results: HCPs reported ongoing challenges in integrating novel therapies in clinical practice, including individualizing treatment plans and sequencing (28%), keeping up with clinical evidence (24%), and differentiating available immunotherapy and combination regimens (14%). Additionally, HCPs reported challenges in providing patient-centered supportive care (12%) and engaging patients in shared decision-making (10%). Most HCPs routinely tested for PD-L1 (82%), HER2 expression (63%) and alteration (55%), and FGFR (62%) , and <50% tested PIK3CA and CDKN2A alterations. While HCPs felt confident in applying the latest guidelines to treatment selection (62%), only 45% of cisplatin-ineligible patients were reported to have received approved first-line immunotherapy combination in the metastatic setting. Most HCPs felt confident recognizing and managing immune-related adverse events (64%) and reported that only 15% of patients required treatment discontinuation due to adverse events. Only 21% of HCPs were fully satisfied with MDT coordination/communication and believed that improving MDT collaboration (33%) and provider education on integrating immunotherapy and combination approaches (31%) would most improve mUC care. After participating in a network-wide workshop, teams developed action plans including improving MDT coordination, standardizing and streamlining biomarker testing, and increasing education on treatment sequencing guidelines. Following integration of these action plans, 100% of HCPs reported improved/increased alignment with evidence-based guidelines. Additionally, HCPs reported increasing provider education on integrating immunotherapy and combination therapies into practice (71%) and improving MDT collaboration (71%). Conclusions: These data and actionable insights can inform future targeted initiatives to improve integration of evidence-based immunotherapy and combination targeted agents into practice for patients with mUC.