Trends and Appropriateness of Perioperative Chemotherapy for Muscle-invasive Bladder Cancer

Contemporary guidelines recommend cystectomy with neoadjuvant or adjuvant cisplatin-based chemotherapy given with curative intent for patients with resectable muscle-invasive bladder cancer (MIBC). However, rates and appropriateness of perioperative chemotherapy utilization remain unclear.

We therefore sought to characterize use of perioperative chemotherapy in older radical cystectomy MIBC patients and examine factors associated with use.

Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified patients with MIBC diagnosed between 2004 and 2013 and treated with radical cystectomy. We classified patients into 3 treatment groups: cystectomy alone, neoadjuvant, or adjuvant chemotherapy. Chemotherapy was classified by regimen. We then fit a multinomial multivariable logistic regression model to assess association between patient factors with the receipt of each treatment.

We identified 3,826 eligible patients. The majority (484; 65%) received cystectomy alone. Neoadjuvant (676; 18% overall, 69% cisplatin-based), and adjuvant chemotherapy (666, 17% overall, 55% cisplatin-based) were used in similar proportions of cystectomy patients. Over the study period, the odds of receiving adjuvant chemotherapy decreased by 7.5%, whereas neoadjuvant therapy increased by 27.5% (both P < 0.001). There was an increase in use of cisplatin-based regimens in the neoadjuvant setting (35 to 72%, P < 0.001), but not the adjuvant setting. Female gender, lower comorbidity, married status, and lower stage disease were associated with greater odds of receiving neoadjuvant chemotherapy (all P < 0.05).

From 2004 to 2013 use of neoadjuvant chemotherapy for MIBC increased while use of adjuvant chemotherapy decreased. Future studies examining barriers to appropriate chemotherapy use, and the comparative effectiveness of neoadjuvant versus adjuvant chemotherapy are warranted.

Urologic oncology. 2019 Apr 30 [Epub ahead of print]

Liam C Macleod, Jonathan G Yabes, Michelle Yu, Mina M Fam, Nathan E Hale, Robert M Turner, Samia H Lopa, Jeffrey R Gingrich, Tudor Borza, Ted A Skolarus, Benjamin J Davies, Bruce L Jacobs

Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: ., Department of Medicine, University of Pittsburgh, Pittsburgh, PA. Electronic address: ., Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: ., Jersey Shore University Medical Center, Neptune, NJ. Electronic address: ., Department of Urology, Charleston Area Medical Center, Charleston, WV. Electronic address: ., Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: ., Department of Medicine, University of Pittsburgh, Pittsburgh, PA. Electronic address: ., Division of Urology, Department of Surgery, Duke University, Durham, NC. Electronic address: ., Department of Urology, University of Wisconsin, Madison, WI. Electronic address: ., Dow Division for Urologic Health Service Research, Department of Urology, University of Michigan, Ann Arbor, MI; VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI. Electronic address: ., Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: ., Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: .

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