Management of metastatic urothelial cancer: the role of surgery as an adjunct to chemotherapy

Svatek, Robert S.; Siefker‐Radtke, Arlene O.; Dinney, Colin P.N.

doi:10.5489/cuaj.1203

Cited by 27 publications

(27 citation statements)

References 20 publications

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“…Hospitalizations were common, with more than 90% of patients experiencing at least one hospitalization. In our sample there was a median (IQR) of three (1-4) hospitalizations per patient, which increased significantly as patients received additional LOTs, from two (1-3) hospitalizations in the nochemotherapy group to four (3)(4)(5)(6) hospitalizations in the LOT3þ group (Table 2). The median (IQR) time to first hospitalization from diagnosis was 3.7 (1.9-8.9) weeks.…”

Section: Healthcare Resource Usementioning

confidence: 83%

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Overall survival, costs, and healthcare resource use by line of therapy in Medicare patients with newly diagnosed metastatic urothelial carcinoma

Aly

Johnson

Yang

et al. 2019

Journal of Medical Economics

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Aims: Medicare patients with metastatic or surgically unresectable urothelial carcinoma (mUC) often receive platinum-based chemotherapy as first line of therapy (LOT), but invariably progress, requiring additional LOTs and healthcare resource use (HCRU). To better understand the evolving mUC treatment landscape, the economic burden of chemotherapy-based mUC treatments among US Medicare patients was estimated. Methods: Newly diagnosed Medicare patients with mUC were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Patients were followed from diagnosis to death, disenrollment, or end of study to characterize LOTs (first [LOT1], second [LOT2], and third or greater [LOT3þ]). Kaplan-Meier methods were used to estimate overall survival (OS) by LOT. HCRU and mean costs were reported over the follow-up period, LOT duration, and maximum LOT received. Results: Among 1,873 eligible patients with mUC (median age ¼ 77 years; median follow-up ¼ 7.5 months), 1,035 (55%) received no chemotherapy. Among chemotherapy-treated patients, 61% had LOT1 only, 25% had LOT1 and LOT2 only, and 14% had LOT3þ. Median OS was 8.1 months, range was 4.3 (untreated) to 29.8 (LOT3þ) months. HCRU frequency increased with additional LOTs. Mean cumulative per-patient cost was $82,912 for all patients, increasing with additional LOTs (untreated ¼ $57,207; LOT1 ¼ $99,213; LOT2 ¼ $125,190; LOT3þ ¼ $163,884). Mean per patient per month cost was $18,827 for all patients, decreasing with increasing number of LOTs received (untreated ¼ $27,211; LOT1 ¼ $9,601; LOT2 ¼ $7,325; LOT3þ ¼ $6,017). Limitations: Potential for treatment misclassification when using the algorithm defining LOTs and non-generalizability of results to younger patients. Conclusions: Over 50% of Medicare patients with mUC received no chemotherapy. Among chemotherapy-treated patients, most received only one LOT. Additional LOTs led to higher mean costs and HCRU, but as patients were followed longer, monthly costs decreased. As treatments evolve to include immuno-oncology agents, these findings provide a clinically relevant economic benchmark for mUC treatment across different traditional LOTs. ARTICLE HISTORY

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Section: Healthcare Resource Usementioning

confidence: 83%

“…Among those diagnosed with UC, about 20% of patients present with de novo metastatic or surgically unresectable UC (mUC). Furthermore, approximately 50% of patients presenting with muscle-invasive UC develop metastatic recurrence after initial therapy for clinically localized disease 4 .…”

Section: Introductionmentioning

confidence: 99%

Overall survival, costs, and healthcare resource use by line of therapy in Medicare patients with newly diagnosed metastatic urothelial carcinoma

Aly

Johnson

Yang

et al. 2019

Journal of Medical Economics

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“…The treatment of choice for metastatic bladder cancer is chemotherapy, which is rarely curative. Currently, the combination of gemcitabine and cisplatin and the MVAC scheme (methotrexate, vinblastine, doxorubicin and cisplatin) are established treatments with reported tumour remission rates up to 70% (8,9). Prognosis, however, is poor.…”

Section: Discussionmentioning

confidence: 99%

Cutaneous Metastases from Urothelial Carcinoma of the Bladder: A Rare Presentation and Literature Review

et al. 2014

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“…Approximately 20% of patients present with advanced disease and are candidates for systemic chemotherapy [5].…”

Section: Introductionmentioning

confidence: 99%

SEOM clinical guidelines for the treatment of invasive bladder cancer

et al. 2011

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The purpose of this article is to provide updated recommendations for the diagnosis and treatment of muscle- invasive and metastatic bladder cancer. The diagnosis of muscle-invasive bladder cancer is made by transurethral resection and following histopathologic evaluation. Invasive bladder cancer should be staged according to the UICC system. Patients with confirmed muscle-invasive bladder cancer should be staged by computed tomography scans of the chest, abdomen and pelvis. Radical cystectomy is the treatment of choice for both sexes and lymph node dissection should be an integral part of cystectomy. In muscle- invasive bladder cancer (cT2-4aN0M0) patients with good performance status (PS 0-1) and correct renal function, neoadjuvant chemotherapy should be recommended. Adjuvant chemotherapy is widely used in high-risk patients with pathologic stage T3 or T4 and/or positive nodes and within clinical trials. Multimodality bladder-preserving treatment in localised disease is currently regarded only as an alternative in selected, well informed and compliant patients for whom cystectomy is not considered for clinical or personal reasons. In metastatic disease, the first-line treatment for patients is cisplatin-containing combination chemotherapy. Recently, vinflunine has been approved in Europe for second-line treatment and is an option for second-line therapy in patients progressing to first-line platinum-based chemotherapy.

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Management of metastatic urothelial cancer: the role of surgery as an adjunct to chemotherapy

Cited by 27 publications

References 20 publications

Overall survival, costs, and healthcare resource use by line of therapy in Medicare patients with newly diagnosed metastatic urothelial carcinoma

Overall survival, costs, and healthcare resource use by line of therapy in Medicare patients with newly diagnosed metastatic urothelial carcinoma

Cutaneous Metastases from Urothelial Carcinoma of the Bladder: A Rare Presentation and Literature Review

SEOM clinical guidelines for the treatment of invasive bladder cancer

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