SUO 2017: Cost-effectiveness Analysis Of A Biomarker-based Approach To Select Patients With Muscle-invasive Bladder Cancer For Neoadjuvant Chemotherapy

Washington, DC ( Neoadjuvant chemotherapy (NAC) is a standard of care for muscle-invasive bladder cancer (MIBC), however utilization is still low due to suboptimal response rates, potential delay in radical cystectomy (RC), and toxicity. There have been some published studies demonstrating the ability of biomarkers to predict response to NAC.

The u authors aimed to evaluate the cost-effectiveness (CE) of a biomarker-based approach to select patients for NAC prior to RC. Data from locally-advanced bladder cancer treated by RC regarding stage distributions, overall survival (OS), cost, overall and biomarker-based response to NAC was derived from the most recently available clinical studies. Furthermore, a decision analysis model was developed to evaluate the CE of biomarker-based approaches to properly select patients with MIBC (T2-T4aN0M0) for NAC. The comparison of CE included several groups: RC alone, RC + NAC in all-comers (unselected), and RC + NAC based on 3 specific biomarkers (mutations in DNA repair genes (ATM, RB1, FANCC), mutations in the excision repair cross-complementation group 2 (ERCC2) gene, and RNA subtypes [basal, luminal, p53-like]).

Results demonstrated that the least effective strategy is RC alone with an average 5-year OS of 54.2% and mean survival of 2.71 years. For strategies of NAC prior to RC without a biomarker, 5-year OS was 60.2% if all get NAC and 55.4% if only 20% of them accept NAC. Lastly, in the biomarker-based approach, the arms driven by subtyping and mutations in the DNA repair genes had 5- year OS of 63.8% and 63.4%, respectively. Two of the biomarker-based approaches using a DNA repair gene panel (mean OS of 3.17 years, $30,992 / life year) and RNA subtyping (mean OS of 3.19 years, $31,487 / life year) were more cost effective when compared with unselected NAC (mean OS of 3.01 years, $32,129 / life year) and RC alone (mean OS of 2.71 years, $35,259 / life year).

This study showed that a biomarker-based strategy to identify MIBC patients who should undergo NAC was more cost effective than unselected use of NAC or RC alone.

Presented by: Solomon L. Woldu, UT Southwestern Medical Center, Dallas, TX, USA

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan, at the 18th Annual Meeting of the Society of Urologic Oncology, November 29-December 1, 2017 – Washington, DC