Treatment patterns and outcomes in metastatic bladder cancer in community oncology settings.

Abstract

396 Background: Current real-world data on treatment patterns in metastatic bladder cancer in the community setting are limited. This study describes patient characteristics, treatment patterns, and efficacy outcomes for these patients in the community setting. Methods: Medical records data from adults diagnosed with stage IV or metastatic bladder cancer between 1/1/2008 and 6/1/2015 were retrospectively collected from a network of 10 US community oncology practices. Patient characteristics, treatment patterns, and efficacy outcomes were assessed. Comparisons across groups were conducted using standard analyses. Progression-free survival and overall survival (OS) were assessed using Kaplan-Meier analysis. Results: Of 508 patients, 75% were male, 79% white, 15% African American, and 71.5% were age ≥65 years (median age, 71 years; range 35-92 years). Overall, 76.4% were current or past tobacco users. The most prevalent comorbidities were diabetes (23.4%), renal disease (16.5%), and chronic obstructive pulmonary disease (COPD; 12.4%). Patients age ≥65 years vs <65 years had higher rates of renal disease (19.6% vs 9.0%; P=0.004), COPD (14.6% vs 6.9%; P=0.017) and congestive heart failure (CHF; 6.3% vs 2.1%; P=0.049), respectively. First-line platinum-based therapy was given to 56.3% of the patients, with the most common regimen being gem + carbo (23.6%) followed by gem + cis (17.0%). Overall, median OS was 9.4 months from diagnosis, 11.0 months from start of line-1, and 5.3 months from start of line-2. Cox regression analysis of OS from diagnosis showed that males (hazard ratio [HR]=1.26; P=0.046) and patients with impaired performance (HR=2.137; P<0.001) were at greater risk of death. Conclusions: Although platinum-based chemotherapy is currently the preferred treatment for metastatic bladder cancer in the community setting, there is a large unmet need in this population, particularly among the elderly. Gender and performance status were associated with efficacy outcomes.