METASTATIC bladder cancer (mBC) poses a significant clinical challenge, with patient survival rates remaining poor despite advances in cancer treatment. For decades, the cornerstone of mBC therapy has been platinum-based chemotherapy, using either cisplatin or carboplatin, aimed at prolonging survival. However, this approach often involves balancing survival benefits with potential impacts on quality of life, necessitating a shared decision-making process between patients, their families, and healthcare providers.
Clinical trials, which form the basis of treatment guidelines, typically include patients with favourable health profiles, limiting the applicability of results to real-world populations. For many patients, treatment outcomes differ from clinical expectations, complicating decisions about systemic therapy. Real-world studies have highlighted that a majority of mBC patients do not commence systemic treatment, with carboplatin being the preferred option in those who do. Median survival durations vary significantly, from 12.9 months for cisplatin-treated patients to 2.5 months for those without systemic treatment.
Real-world data underline that only a minority of patients complete the recommended 4–6 chemotherapy cycles. Factors such as poor performance status and female sex are linked to a reduced likelihood of completing treatment. Women, for example, face a higher risk of treatment toxicity and may experience less social support, potentially influencing their ability to tolerate treatment.
Among patients who complete treatment, adjustments such as dose reductions are common, often due to side effects. These modifications may compromise treatment effectiveness, with suboptimal chemotherapy doses linked to poorer survival outcomes. Moreover, one in five patients who failed to complete treatment died within a month of discontinuation, suggesting that systemic therapy might not have been the best option in some cases.
Emerging treatments, including combinations of chemotherapy and immune checkpoint inhibitors, offer hope for better outcomes. However, disparities in patient eligibility and access to new therapies mean that traditional chemotherapy will remain vital for many. Incorporating real-world evidence into treatment planning and guideline development is essential to ensure patients receive care aligned with their needs and expectations.
Reference
Slotman E et al. Guidelines versus real-world data in metastatic bladder cancer: a population-based study on first-line chemotherapy treatment patterns. Urol Oncol. 2024;DOI:10.1016/j.urolonc.2024.10.026.
