Survival disparities by race in advanced urothelial carcinoma (aUC): A real-world analysis.

668 Background: Retrospective population data suggest poorer survival for non-White aUC patients. However, data on survival disparities in the era of immuno- and targeted therapies is limited. Methods: This cohort study used Flatiron Health’s nationwide de-identified electronic health record (EHR)-derived database. 7,244 patients (pts) were identified. Pts who started systemic therapy for aUC from 1/1/2017 to 5/1/2024 and had a recorded race were included. Baseline demographics, including social determinants of health (SDOH) score, performance status (PS), disease characteristics, treatment history, and clinical outcomes were abstracted. Progression free survival (PFS) and overall survival (OS) were compared between Black, White and Asian patients via Kaplan-Meier log-rank analysis and Cox proportional hazards models. Independent sample t-tests and chi-square analyses were used for univariate comparisons. P-values &lt; 0.05 were considered statistically significant. Results: A total of 2,388 pts with aUC were identified, with 1.4% Asian, 5.2% Black, 14.4% “other,” and 78.9% White. In 1L, 17.9% received immunotherapy (IO) monotherapy, 4.2% received enfortumab vedotin + pembrolizumab (EVP), 37.5% received carboplatin-based regimens (carbo), 27.8% cisplatin-based regimens (cis), and 12.5% other chemotherapy (p=0.317). ECOG PS&gt;1 at diagnosis was associated with non-White race (p=0.022). Black patients received treatment at an academic center (41.0%) more often than White patients (25.6%; p&lt;0.001). Black pts had lower SDOH score compared White (p&lt;0.001). Asian (HR0.73, p=0.3) and Black (HR1.07, p=0.3) pts had similar PFS to White pts, as well as similar OS with HR0.85(p=0.4) and HR1.05(p=0.4), respectively. On Cox univariate analysis, there was no significant 1L PFS difference between White, Asian, and Black pts on cis (n=665, p=0.3), carbo (n=895, p=0.7), EVP (n= 25, p=0.8), or IO (n=428, p=0.3). OS was not significantly different by race for any 1L therapy. Conclusions: In a large real-world database, race did not affect overall aUC survival. Baseline characteristics and survival by race. Black (n=124) White (n=1884) Asian (n=33) Other (n=344) Sig (p) Baseline Characteristics ECOG PS 0-1 (%) 55.5 64.6 58.2 62.1 0.027 2-4 (%) 18.5 15.5 19.4 15.2 Academic treatment center (%) 36.6 25.9 13.4 13.2 &lt;0.001 Mean SDOH score (0-5) 2.27 3.26 3.38 2.97 &lt;0.001 1L Treatment IO (%) 23.8 16.4 20.0 17.5 0.317 EVP (%) 5.7 3.9 4.4 4.0 Carbo (%) 32.9 36.5 37.4 38.0 Cis (%) 27.4 29.2 27.8 29.8 Other (%) 10.2 14.0 10.4 10.7 Survival 1L mPFS (m) 5.2 4.6 5.1 4.2 <jats:td colspan="1" rowsp