Few patients with metastatic urothelial carcinoma of the bladder are surviving as long in the real-world as those in clinical trials, according to new research.
Current overall survival projections for patients with metastatic urothelial carcinoma of the bladder are a median 8 to 16 months and are based largely on data from patients treated in clinical trials. Patients enrolled in trials are highly-selected, so the degree to which this outcome reflects real-world experience has yet to be studied.
William Parker, MD, Mayo Clinic (Rochester, MN), and colleagues examined practice patterns and survival for patients with such disease in the National Cancer Database between 2004 and 2012. A total of 3374 patients were sampled (median age, 71; 70% male). Sites of metastases were characterized as non-regional lymph node only or any visceral metastatic disease. Majority of patients were diagnosed with visceral metastatic disease (n = 2486; 82%). The study’s findings were published in The Journal of Urology (April 2017;197:e426-e427).
Results of the examination showed that real-world patients had a poor overall survival, with approximately 27% surviving 1 year after diagnosis. Median overall survival was 5.5 months. Patients with visceral metastases had comparatively worse overall survival than those with non-regional lymph node (5.0 months vs 11.1 months, respectively).
Additionally, researchers found significant differences in overall survival based on treatment type: multimodal (12.6 months), chemotherapy (10.6 months), radiation (6.9 months), and surgery (5.4 months). More than 50% of patients received palliative care alone and survived a median of 4.8 months. Patients who did not receive any treatment survived a median of 2.0 months.
“Only patients with metastases to non-regional lymph nodes treated with chemotherapy experienced an overall survival similar to that reported in clinical trials,” Dr Parker said in a press release (May 23, 2017). “We should therefore interpret survival outcomes from randomized controlled trials cautiously, as few patients experience comparable survival in real-world practice.”—Zachary Bessette