The following is a summary of “Chemotherapy, immunotherapy, or combination first-line treatment for metastatic urothelial carcinoma of the bladder: A large real-world experience,” published in the May 2024 issue of Urology by Ranganathan et al.
Optimal first-line therapy for metastatic urothelial carcinoma of the bladder (mUC) remains debated, typically involving platinum-based chemotherapy, with PD1/L1 inhibitors reserved for select cases. Despite trials on combination chemotherapy, no clear superiority over chemotherapy alone has emerged. This study utilizes real-world data to analyze clinical and sociodemographic factors influencing the choice between chemotherapy, immunotherapy, or combination therapy and assesses their impact on overall survival (OS).
Using the National Cancer Database, researchers identified 4,169 patients diagnosed with stage IV mUC from 2014 to 2018, treated with first-line immunotherapy, chemotherapy, or combination therapy. Multivariable logistic regression modeled factors associated with treatment selection, while adjusted Kaplan-Meier and Cox proportional hazards regression analyzed OS differences among treatments.
Multivariable analysis revealed older age (RRR: 1.07, 95% CI, 1.06–1.08) and higher comorbidity burden as predictors favoring immunotherapy over chemotherapy. Treatment at academic centers correlated with higher odds of receiving combination therapy (RRR: 1.29, 95% CI, 1.01–1.65). In propensity-weighted analyses, combination therapy showed improved OS (HR: 0.72; 95% CI, 0.62–0.83) compared to chemotherapy alone.
Older age and increased comorbidity were associated with a greater likelihood of receiving immunotherapy rather than chemotherapy in first-line treatment for metastatic bladder cancer. Combination chemoimmunotherapy, more frequently administered at academic institutions, was linked to better survival outcomes than chemotherapy alone. These findings underscore the influence of patient characteristics and treatment settings on therapeutic decisions and outcomes in mUC.
Source: sciencedirect.com/science/article/abs/pii/S1078143924004289