Treatment Patterns and Outcomes in Stage IV Bladder Cancer in a Community Oncology Setting: 2008-2015

• Published in: Clinical genitourinary cancer 2018-12, Vol.16 (6), p.e1171-e1179
• Main Authors: Fisher, Maxine D., Shenolikar, Rahul, Miller, Paul J., Fenton, Moon, Walker, Mark S.
• Format: Article
• Language: English
• Subjects: Effectiveness; Overall survival; Platinum-based chemotherapy; Progression-free survival; Real-world data
• ISSN: 1558-7673; 1938-0682
• DOI: 10.1016/j.clgc.2018.07.025

Current real-world data regarding treatment patterns in advanced bladder cancer in the community setting are limited. This study describes patient characteristics, treatment patterns, and effectiveness outcomes for stage IV bladder cancer in the community setting. Medical records data of adults diagnosed with stage IV bladder cancer between January 1, 2008 and June 1, 2015 were retrospectively collected from a network of United States community oncology practices. Patient characteristics, treatment patterns, and efficacy outcomes were assessed. Across-group comparisons were conducted using bivariate analyses. Kaplan-Meier and Cox regression analyses of progression-free survival and overall survival (OS) were conducted. Of 508 patients (mean age, 70 ± 11 years), 75.2% were male, 79.1% white, 15.4% black, and 71.5% were ≥ 65 years. The most prevalent comorbidities were diabetes (23.4%) and renal disease (16.5%). Overall, 56% of patients received first-line platinum-based chemotherapy; the most common regimen was gemcitabine/carboplatin (23.6%), followed by gemcitabine/cisplatin (17%). The median OS was 9.4 months from stage IV bladder cancer diagnosis and 8.4 months from start of first-line therapy. Cox regression analysis of OS from diagnosis showed a higher risk of death for patients with no treatment (hazard ratio [HR], 2.06; P < .0001) or other treatment (HR, 1.83; P = .002) versus cisplatin and for patients with impaired performance (HR, 2.05; P < .0001). Platinum-based chemotherapy was the most prescribed treatment for stage IV bladder cancer in the community setting. Several patients were not treated with any chemotherapy, although we did not observe the reason for no treatment. This study highlights an unmet need in this population, particularly in a relapsed/refractory setting, and the need for improvement in outcomes. There are limited data on treatment patterns of patients with advanced bladder cancer in the community setting. This study sought to provide a comprehensive analysis of this patient population by retrospective screening of medical records. Results indicate that mainly platinum-based chemotherapy was mostly prescribed, although several patients remained untreated. This illustrates the importance to highlight the unmet medical/therapeutic needs in community settings.