Treatment patterns among US patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC) during 2021–2024: Retrospective cohort study using the IQVIA database.
Abstract
702 Background: MIBC is an aggressive disease with suboptimal patient (pt) outcomes. Neoadjuvant (NADJ) and adjuvant (ADJ) therapies have demonstrated improved survival when added to radical cystectomy (RC), but their use in the real-world remains limited. This study described recent real-world treatment patterns and unmet need in NADJ and ADJ settings among US pts with MIBC who underwent RC. Methods: This retrospective observational cohort study used data from an IQVIA US closed claims database repository of adjudicated medical and pharmacy claims from >140 million commercially insured and Medicare Advantage beneficiaries. Adult pts who underwent RC on or after a UC diagnosis between 1/1/21 and 6/30/24 and had ≥12 months of continuous enrollment pre-RC were included; all pts had ≥6 months post-RC follow-up. NADJ therapy was defined as any treatment from 180 days until the day before RC; ADJ therapy was any treatment within 120 days post-RC through discontinuation, progression to locally advanced/metastatic UC, or end of follow-up, whichever came first. All analyses were descriptive. Results were stratified by age (<65 y; ≥65 y) and setting (NADJ and ADJ). Results: Overall, 964 pts with UC diagnosis received RC; mean (SD) index age was 65.4 (10.6) y and 72.7% were male. 55.4% of pts did not receive any NADJ or ADJ therapy; NADJ and ADJ therapies were used in 36.2% and 16.3% of pts, respectively. Estimated interval from end of NADJ therapy to RC was 5–6 wks, and ADJ therapy started a median of ~9 wks post-RC; both were similar across evaluated subgroups. NADJ and ADJ therapy use was numerically higher in pts <65 y vs ≥65 y (NADJ: 43.8% vs 29.8%; ADJ: 20.1% vs 13.0%). Conclusions: This real-world analysis suggests low uptake of NADJ and ADJ therapies among pts undergoing RC despite guideline recommendations, highlighting potential opportunities to optimize use among eligible patients. NADJ and ADJ treatment regimens. Regimen, n/N (%) Total NADJ (N=349) <65 y NADJ (n=194) ≥65 y NADJ (n=155) Total ADJ (N=157) <65 y ADJ (n=89) ≥65 y ADJ (n=68) Platinum-based chemotherapy 302/349 (86.5) 178/194 (91.7) 124/155 (80.0) 27/157 (17.2) 20/89 (22.5) 7/68 (10.3) Cisplatin-based 287/302 (95.0) 173/178 (97.2) 114/124 (92.7) 19/27 (70.4) 14/20 (70.0) 5/7 (71.4) Cisplatin + gemcitabine 169/287 (58.9) 91/173 (52.6) 78/114 (68.4) 14/19 (73.7) 10/14 (71.4) 4/5 (80.0) MVAC 100/287 (34.8) 71/173 (41.0) 29/114 (25.4) 4/19 (21.1) 3/14 (21.4) 1/5 (20.0) Other 18/287 (6.3) 11/173 (6.4) 7/114 (6.1) 1/19 (5.3) 1/14 (7.2) 0 Non-platinum chemotherapy 35/349 (10.0) 11/194 (5.7) 24/155 (15.5) 6/157 (3.8) 3/89 (3.4) 3/68 (4.4) Immunotherapy 8/349 (2.3) 3/194 (1.5) 5/155 (3.2) 116/157 (73.9) 62/89 (69.7) 54/68 (79.4) EV monotherapy/EV combinations 4/349 (1.1) 2/194 (1.0) 2/155 (1.3) 8/157 (5.1) 4/89 (4.5) 4/68 (5.9)