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