Perioperative Treatment Patterns for Muscle-Invasive Bladder Cancer Patients Undergoing Radical Cystectomy in the Adjuvant Immunotherapy Era: A Retrospective Analysis of US Community Oncology Practice

INTRODUCTION: Patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC) and pelvic lymph node dissection (PLND) often receive perioperative systemic therapy. However, treatment patterns are evolving with the advent of adjuvant immunotherapy. We examined recent trends in perioperative treatment management in a contemporary cohort of US patients with MIBC undergoing RC in the immunotherapy era. METHODS: We conducted this retrospective, real-world study utilizing N-Power Medicine's Bladder Analytical Dataset to describe demographics, clinical characteristics, and treatment patterns among patients with MIBC who underwent RC between 2021 and 2023. Treatment patterns were further stratified by pathologic high risk of recurrence following RC (ypT2-T4a orypN+; pT3-4a or pN+). RESULTS: A total of 138 patients with MIBC who underwent RC were included. The majority were male (82%) and White (83%). Overall, 49% (67/138) of patients received RC without neoadjuvant or adjuvant treatment. Approximately 46% (64/138) received neoadjuvant treatment, mainly gemcitabine and cisplatin. Only 14% (20/138) of all patients received any adjuvant treatment, including 10% (14/138) who received adjuvant nivolumab. Less than 10% of patients (9.4%, 13/138) received both neoadjuvant and adjuvant treatments. Among patients with known pathological staging post-RC (n = 125), approximately half had high risk of disease recurrence (50.4%, 63/125). Among high-risk patients, 22% (14/63) received adjuvant treatment, with 19% (12/63) specifically receiving nivolumab. CONCLUSION: In this contemporary cohort of patients with MIBC undergoing RC, nearly half received neoadjuvant treatment whereas the use of adjuvant treatment was limited. Since Food and Drug Administration (FDA) approval, adjuvant nivolumab use was approximately 10% in the overall cohort of patients with MIBC treated with RC, and less than 20% among those with a high risk of disease recurrence.