scholarly journals Survival Outcomes Associated with First and Second-Line Palliative Systemic Therapies in Patients with Metastatic Bladder Cancer

2021 ◽  
Vol 28 (5) ◽  
pp. 3812-3824
Author(s):  
Arshia Beigi ◽  
Saba Vafaei-Nodeh ◽  
Longlong Huang ◽  
Shaun Z. Sun ◽  
Jenny J. Ko
Keyword(s):  
Bladder Cancer ◽  
Real World ◽  
Stage Iv ◽  
Survival Outcomes ◽  
Second Line ◽  
Real World Data ◽  
Treatment Start ◽  
Metastatic Bladder Cancer ◽  
Start Dates ◽  
Systemic Therapies

Background: Real-world data on palliative systemic therapies (PST) in treating metastatic bladder cancer (mBC) is limited. This study investigates current trends in treating mBC with first- (1L) and second-line (2L) chemotherapy (CT) and immunotherapy (IT). Methods: A chart review was conducted on patients diagnosed with stage II-IV bladder cancer in 2014–2016. Survival outcomes were compared between chemotherapy, immunotherapy, and supportive care. Results: out of 297 patients, 77% were male. 44% had stage IV disease at diagnosis. Median age at metastasis was 73 years. 40% of patients received 1L PST and 34% received 2L PST. Median overall survival (mOS) was longer in those receiving PST versus no treatment (p < 0.001). Patients receiving CT and IT sequentially had the longest mOS (18.99 months). First-line IT and CT mOS from treatment start dates were 5.03 and 9.13 months, respectively (p = 0.81). Gemcitabine with cisplatin (8.88 months) or carboplatin (9.13 months) were the most utilized 1L chemotherapy regimens (p = 0.85). 2L IT and CT mOS from treatment start dates were 6.72 and 3.78 months, respectively (p = 0.15). Conclusion: real-world mOS of >1.5 years in mBC is unprecedented and supports using multiple lines of PST. Furthermore, immunotherapy may be a comparable alternative to chemotherapy in both 1L and 2L settings.

scholarly journals Treatment patterns and clinical outcomes of chemotherapy treatment in patients with muscle-invasive or metastatic bladder cancer in the Netherlands

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Daan J. Reesink ◽  
Ewoudt M. W. van de Garde ◽  
Bas. J. M. Peters ◽  
Paul B. van der Nat ◽  
Maartje Los ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Real World ◽  
Treatment Patterns ◽  
Second Line ◽  
Chemotherapy Treatment ◽  
First Line ◽  
Real World Data ◽  
World Data ◽  
Metastatic Bladder Cancer ◽  
Muscle Invasive

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.

scholarly journals Application of Health Technology Assessment (HTA) to Evaluate New Laboratory Tests in a Health System: A Case Study of Bladder Cancer Testing

2020 ◽  
Vol 7 ◽  
pp. 237428952096822
Author(s):  
Erik J. Landaas ◽  
Ashley M. Eckel ◽  
Jonathan L. Wright ◽  
Geoffrey S. Baird ◽  
Ryan N. Hansen ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Pilot Study ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Real World ◽  
Health Technology ◽  
Test System ◽  
Real World Data ◽  
World Data

We describe the methods and decision from a health technology assessment of a new molecular test for bladder cancer (Cxbladder), which was proposed for adoption to our send-out test menu by urology providers. The Cxbladder health technology assessment report contained mixed evidence; predominant concerns were related to the test’s low specificity and high cost. The low specificity indicated a high false-positive rate, which our laboratory formulary committee concluded would result in unnecessary confirmatory testing and follow-up. Our committee voted unanimously to not adopt the test system-wide for use for the initial diagnosis of bladder cancer but supported a pilot study for bladder cancer recurrence surveillance. The pilot study used real-world data from patient management in the scenario in which a patient is evaluated for possible recurrent bladder cancer after a finding of atypical cytopathology in the urine. We evaluated the type and number of follow-up tests conducted including urine cytopathology, imaging studies, repeat cystoscopy evaluation, biopsy, and repeat Cxbladder and their test results. The pilot identified ordering challenges and suggested potential use cases in which the results of Cxbladder affected a change in management. Our health technology assessment provided an objective process to efficiently review test performance and guide new test adoption. Based on our pilot, there were real-world data indicating improved clinician decision-making among select patients who underwent Cxbladder testing.

2624 The effectiveness of chemotherapy in “real world” patients with metastatic bladder cancer

2015 ◽  
Vol 51 ◽  
pp. S520-S521 ◽  
Author(s):  
M.D. Galsky ◽  
S.K. Pal ◽  
S.W. Lin ◽  
S. Ogale ◽  
J. Simpson ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Real World ◽  
Metastatic Bladder Cancer

scholarly journals PCN266 - A REAL-WORLD DATA STUDY REGARDING HOSPITAL RESOURCES USE AND COSTS ASSOCIATED WITH BLADDER CANCER IN SPAIN

2018 ◽  
Vol 21 ◽  
pp. S59
Author(s):  
A. De Prado ◽  
Baltasar-Sanchez Á ◽  
V. Gómez-Navarro ◽  
C. Barrull ◽  
A. Carreño-Serra ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Real World ◽  
Real World Data ◽  
World Data ◽  
Hospital Resources

Survival trends among patients with metastatic bladder cancer in the United States.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 306-306
Author(s):  
Binay Kumar Shah ◽  
Rakesh Mandal
Keyword(s):  
United States ◽  
Bladder Cancer ◽  
Survival Rates ◽  
Age Groups ◽  
Stage Iv ◽  
Relative Survival ◽  
The United States ◽  
Ajcc Stage ◽  
Metastatic Bladder Cancer ◽  
Z Value

306 Background: The chemotherapy regimens for metastatic bladder cancer (MBC) have evolved over the last two decades. Due to favorable toxicity profile, a combination of cisplatin and gemcitabine is widely used for the treatment of MBC since 2000. It is unclear if the survival trend in MBC has changed over last two decades. This study was conducted to evaluate the relative survival rates for patients with MBC in the United States during 1991-1999 and 2000-2008. Methods: We used the Surveillance, Epidemiology, and End Results (SEER*Stat) program to analyze 6-month and 12-month relative survival rates of AJCC stage-IV bladder cancer patients included in the SEER database. We used Z-test in the SEER*Stat program to compare relative survival rates among cohorts of patients categorized by race, gender, and age groups (<60 and ≥60 years). Results: The dataset comprised 9,819 and 986 patients with AJCC stage-IV bladder cancer among Caucasians and African Americans (AA), respectively. Among Caucasian men (<60 years), 6-month survival rates were 85.4±1.7% (n=442) and 77.9±1.3% (n=1,117) for 1991-1999 and 2000-2008, respectively. Similarly, 12-month survival rates in this group were 68.6±2.2% (n=442) and 60.4±1.5% (n=1,117) for 1991-1999 and 2000-2008, respectively. Thus, both 6-month and 12-month survival rates in 2000-2008 were lower among young Caucasians; and the differences were statistically significant when compared to 1991-1999 (6-month: Z-value = -3.205, p=0.001; 12-month: Z-value= -2.984, p=0.003). The survival rates among AA were not statistically significant. Conclusions: In young Caucasian patients (<60 years) with MBC, 6- month and 12-month relative survival rates were lower for the period 2000-2008 compared to 1991-1999. Further studies may be required to evaluate factors responsible for decreased survival rates among this population.

Health resource utilization and costs for stage IV bladder cancer in community oncology settings.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16032-e16032
Author(s):  
Rahul A. Shenolikar ◽  
Maxine D. Fisher ◽  
Paul J. Miller ◽  
Mark Stephen Walker ◽  
Moon Jung Fenton
Keyword(s):  
Bladder Cancer ◽  
Resource Utilization ◽  
Stage Iv ◽  
Patient Characteristics ◽  
Smoking History ◽  
Health Resource ◽  
Health Resource Utilization ◽  
Monthly Cost ◽  
Metastatic Bladder Cancer ◽  
Community Oncology

e16032 Background: Current real-world data on patients with metastatic bladder cancer in the community setting are limited. This study describes patient characteristics, health resource utilization (HRU), and costs for this population. Methods: Medical records data from adults diagnosed with stage IV bladder cancer (T4b, node-positive, or distant metastatic disease) between 1/1/2008 and 6/1/2015 were retrospectively collected from a network of 10 US community oncology practices. Patient characteristics, HRU, and costs were assessed. Regression models were used to estimate group effects on utilization and costs through three progression-based lines. Results: Of 508 patients, 75% were male, 79% white, 15% African American, and 71.5% were aged ≥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%). Overall, 70.1% had distant metastases at diagnosis, including bone (24.0%), lung (23.4%), and liver (14.6%). Of 341 patients analyzed for HRU and cost, 58.9% had hospital visits and 11.7% had emergency department (ED) visits. Age, smoking history, and presence of diabetes were predictors of hospitalization (all P< 0.05). Overall mean monthly total healthcare cost was $18,778 ± $47,006 (median $6285), which was driven by hospitalizations ($14,660 ± 44,686, median $1717). Mean monthly ED cost was $776 ± $5530, median $0. Mean monthly cost for office visits was $186 ± $189, median $152. Procedures in the medical oncology setting had a mean monthly cost of $707 ± $1179, median $395. Other costs included systemic therapy ($267 ± $704, median $117), infused supportive care drugs ($758 ± $1458, median $0), and other drugs ($1422 ± $3745, median $136). Age, presence of diabetes, presence of any comorbidities, body mass index, and impaired composite performance status were predictors of healthcare costs (all P< 0.05). Conclusions: This study showed significant HRU and costs for metastatic bladder cancer patients suggesting high unmet need.

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