Abstract
This retrospective study was performed to evaluate real-world oncological outcomes of patients treated with chemo-based therapy for muscle-invasive or metastatic bladder cancer (MIBC/mBC) and compare results to data from RCTs and other cohorts. Among 1578 patients diagnosed, 470 (30%) had MIBC/mBC. Median overall survival (mOS) for RC alone (47 months), first-line (13 months) and second-line (7 months) chemotherapy, and chemotherapy for recurrent disease (8 months) were similar to literature. Treatment with neoadjuvant and induction chemotherapy (NAIC) was only utilized in 9% of patients, and often in patients with poor disease status, resulting in a lower mOS compared to literature (35 and 20 months, respectively). Patients treated with chemotherapy had many adversities to treatment, with only 50%, 13%, 18% and 7% of patients in NAIC, first-line, salvage after RC, and second-line setting completing the full pre-planned chemotherapy treatment. Real-world data shows NAIC before RC is underutilized. Adversities during chemotherapy treatment are frequent, with many patients requiring dose reduction or early treatment termination, resulting in poor treatment response. Although treatment efficacy between RCTs and real-world patients is quite similar, there are large differences in baseline characteristics and treatment patterns. Possibly, results from retrospective studies on real-world data can deliver missing evidence on efficacy of chemotherapy treatment on older and ‘unfit’ patients.
Highlights
Patients with muscle invasive bladder cancer (MIBC) with or without metastases have a worse prognosis than patients without muscle invasion
MIBC patients treated with radical cystectomy (RC) and extensive pelvic lymph node dissection (PLND) have a median overall survival of 46 months, which can be prolonged to 77 months with neoadjuvant chemotherapy (NAC)[1]
1641 patients diagnosed with bladder cancer (BCa) were identified from the Netherlands Cancer Registry (NCR) database
Summary
Patients with muscle invasive bladder cancer (MIBC) with or without metastases have a worse prognosis than patients without muscle invasion. Patients with advanced and/or metastatic bladder cancer (mBC) have a mOS of 13–16 months, despite having a response rate of 40–60% in the first-line (1L) setting with cisplatin-based chemotherapy[4,5]. A large retrospective cohort study from the US showed a mOS after RC of 48 months, but does not differentiate between upfront RC and neoadjuvant or induction chemotherapy (NAIC) before RC17. The question whether outcomes from treatment options for bladder cancer (BCa) in the general population (so called real-world setting) are similar compared to results from controlled clinical trials, remains unanswered. The primary objective of this retrospective, observational cohort analysis was to describe treatment patterns and outcomes of patients with MIBC or mBC and a chemo-based therapy within a regional referral network for treatment of BCa in the Netherlands
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