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

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 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.