Characteristics and Treatment Patterns of Patients with Muscle-Invasive Bladder Cancer in the United States: A Real-World Cohort Study

Abstract

Introduction This study reported characteristics and real-world treatment patterns of patients with muscle-invasive bladder cancer after radical cystectomy with or without neoadjuvant therapy in the United States. Patients and Methods This cohort study extracted data from the Inovalon Insights Payer-Sourced© claims dataset (January 1, 2020–December 31, 2021). Eligible patients (≥18 years) diagnosed with bladder cancer who had undergone radical cystectomy with or without neoadjuvant therapy were followed from index date (first day of radical cystectomy or neoadjuvant therapy) until study end, diagnosis of metastasis, or the end of enrollment in their health plan. Neoadjuvant therapy was defined as systemic therapy received ≤6 months before radical cystectomy. Results A total of 332 patients were included (male, 73.8%; median age, 64.0 years). Mean age-adjusted Charlson Comorbidity Index score was 6.3. 41.3% of patients underwent radical cystectomy without neoadjuvant therapy; 58.7% of patients received neoadjuvant therapy. The most frequent type of neoadjuvant chemotherapy was chemotherapy with cisplatin (46.1%): most commonly cisplatin with gemcitabine (22.9%) or cisplatin with doxorubicin, methotrexate, and vinblastine (16.9%). Adjuvant therapy was received by 11.7% of patients; with immunotherapy (6.0%) being the most common treatment. After radical cystectomy or adjuvant therapy, 63 patients received subsequent therapy, most commonly immunotherapy (41.3%). The highest intensity of healthcare resource utilization during the follow-up period was for outpatient visits (mean per-patient per-month, 6.4). Conclusion Many patients underwent radical cystectomy without neoadjuvant or adjuvant therapy, suggesting an unmet need for alternative therapeutic regimens. Given the limitations of this retrospective claims-based design, including reliance on a claims-based muscle-invasive bladder cancer identification algorithm subject to coding errors, absence of clinical context, potential COVID-19 disruptions to care patterns, and a study window predating the approval of several key agents, these findings should be interpreted with caution. Further evaluation of contemporary treatment patterns is needed.