Evolution of treatment distribution and patient characteristics of muscle invasive bladder cancer patients: results from two multi-national real-world surveys

Abstract

To describe the real-world clinical characteristics and treatment distribution of patients with muscle-invasive bladder cancer (MIBC), and to discuss how these patterns have evolved over time. Data were drawn two separate cohorts of the Adelphi Muscle Invasive Urothelial Cancer Disease Specific Programme (DSP™) and the 2023–2024 Adelphi Muscle Invasive Bladder Cancer DSP™, a cross-sectional survey of physicians and their consulting patients. These surveys were conducted in two pseudorandomized samples of physicians and patients Canada, China, Germany and the United Kingdom between January – June 2021 (2021 cohort) and July 2023 – April 2024 (2023–2024 cohort). Physicians reported patient demographics, clinical characteristics, and treatment distribution. Analyses were descriptive. In 2021, 117 physicians provided data for 718 MIBC patients; in 2023–2024, 140 physicians reported on 521 patients, plus 174 patient who had received nivolumab in the adjuvant setting. In 2023–2024, mean (standard deviation) age was 68.5 (9.7) years, BMI 24.8 (3.8) kg/m 2 , and 70% were male; 81% were retired/unemployed. Among patients in the nivolumab cohort with disease staging data ( n = 173), 21% had stage PT2A, 21% PT2B, 23% PT3A, and 62% stage N0; 55% were cisplatin-eligible post-surgery. In 2021, 32% received neoadjuvant therapy only, 30% adjuvant only, and 9% peri-adjuvant (i.e. both neoadjuvant and adjuvant therapy); 17% of adjuvant-only patients received immunotherapy, most often nivolumab or pembrolizumab. In 2023–2024, 29% received neoadjuvant only, 27% adjuvant only, and 19% peri-adjuvant; 23% of adjuvant-only patients received immunotherapy. Despite the approval of adjuvant immunotherapies, such as nivolumab, immunotherapy was received by less than a quarter of patients receiving adjuvant therapy alone or as part of a peri-adjuvant regimen, suggesting there are opportunities to expand immunotherapy use in MIBC.