Treatment patterns of MIBC patients not receiving radical cystectomy: Results from a real-world survey in Europe.
Authors: Eccleston Anthony , Koshy Abin , Brinkmann Julia , Milloy Neil , Manuel Laure , Skilling Jacob , Biondi Emilia , Brown Elliott , Chang Jane 
Published: February 2025

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Background:
Neoadjuvant chemotherapy followed by Radical cystectomy (RC) is the current standard of care for muscle invasive bladder cancer (MIBC). RC is associated with significant risks and quality of life (QoL) implications. This real-world survey aimed to understand the drivers behind why patients (pts) do not receive RC, and alternative treatments initiated with curative intent.
Methods:
Medical oncologists and urologists across France, Germany, Italy, Spain, and the UK were recruited to the Adelphi MIBC Disease Specific Programme (DSP)™ to extract patient medical records for their next 4 consecutive pts with MIBC who did not receive RC. Data was collected Dec 2023 to May 2024.
Results:
200 physicians provided data for 762 pts with MIBC who didn’t receive RC, of whom 388 (51%) refused RC; 357 (47%) were ineligible for RC; and 17 (2%) didn’t receive RC for other reasons. The mean (standard deviation) age of pts was 73.9 (9.3) years; 70.1 (9.2) for pts that refused RC and 78.2 (7.4) for RC ineligible pts. 78% of pts were diagnosed
de novo
MIBC, and 20% of pts progressed from non-invasive disease. When surveyed as to why their pts may refuse RC, the most common reason physicians reported was pts not wanting a stoma (80%), followed by QoL concerns (66%) and concerns with the risk of surgery (48%). When asked which factors they consider when determining a patient’s eligibility for RC, the most common were comorbidities (90%), physical performance status (87%), and cardiac status (68%). Of the 388 pts that refused RC, the top 3 reasons provided by patients for refusal were QoL concerns following RC (71%), not wanting to live with a stoma (59%), and concerns over the risk of surgery (37%). Amongst the 357 RC ineligible pts the most common reasons they were deemed as such were their comorbidities (40%), physical performance status (37%), and cardiac status (11%). Bladder sparing therapy with curative intent (BSTx) was received by 367 (48%) of non-RC pts, of whom 94% had only 1 line. Treatments received at 1
st
line can be seen below. Alongside BSTx non-radical surgery was received by 78% of pts, most commonly transurethral resection (74%) or partial cystectomy (5%). Complete response to 1
st
line BSTx was reported by physicians in 44% of pts. Among pts that refused RC 48% recorded a complete response whilst this was 36% for RC ineligible pts.
Conclusions:
In this analysis, a similar proportion of pts refuse RC as are considered ineligible. There is a need for novel approaches to improve the options available to pts without compromising outcomes.

Treatments received at 1
st
line BSTx n, (%).

All non-RC ptsn=762
Refused RCn=388
RC ineligiblen=357
No RC - other reasonn=17

Chemotherapy only
151 (20)
90 (23)
59 (17)
2 (12)

Radiotherapy only
52 (7)
19 (5)
32 (9)
1 (6)

Chemoradiotherapy
134 (18)
97 (25)
35 (10)
2 (12)

Treatments including immunotherapies
21 (3)
11 (3)
10 (3)
0 (0)

Other treatments
9 (1)
6 (2)
3 (1)
0 (0)

No BSTx
395 (52)
165 (43)
218 (61)
12 (71)