Why Patients With Bladder Cancer Aren’t Receiving Recommended Immunotherapy

Several factors may prevent patients with metastatic bladder cancer from receiving immunotherapy, according to research presented at the Society of Urologic Oncology Annual Meeting 2023.

Researchers found that age, sex, insurance status, comorbidities, treatment facility, and other factors were associated with receipt of immunotherapy.

The study also showed that patients who did not receive immunotherapy had significantly worse overall survival than patients who did.

For this study, researchers analyzed data from the National Cancer Database, looking at trends in immunotherapy utilization for bladder cancer during 2014-2020.

The analysis included 2244 patients with metastatic bladder cancer who were recommended, or planned to receive, immunotherapy as frontline systemic treatment. In this group, 1801 patients ultimately received immunotherapy, and 443 did not.

In a multivariable analysis, several factors were significantly associated with not receiving immunotherapy, including:

• Being uninsured (odds ratio [OR] vs private insurance, 2.82; 95% CI, 1.29-6.16; P =.01)
• Having Medicaid insurance (OR, 1.83; 95% CI, 1.03-3.24; P =.04)
• Older age (OR, 1.02; 95% CI, 1.01-1.03; P =.006)
• Female sex (OR, 1.42; 95% CI, 1.12-1.80; P =.0030)
• Charlson-Deyo score of 3 (OR vs 0, 1.56; 95% CI, 1.11-2.17; P =.01)
• Being diagnosed in 2014 (OR vs 2020, 3.55; 95% CI, 0.47-8.58; P =.005)
• Receiving treatment at a non-academic facility (OR, 1.78; 95% CI, 1.38-2.29; P <.001).

On the other hand, patients were more likely to receive immunotherapy if they had undergone radical cystectomy (OR, 0.38; 95% CI, 0.17-0.84; P =.017) or had prior radiation (OR, 0.7; 95% CI, 0.52-0.94; P =.02).

The researchers also found that patients who received immunotherapy had a significantly lower risk of death than patients who did not (hazard ratio, 0.28; 95% CI, 0.23-0.32; P <.0001).

Disclosures: No disclosures were provided.

Reference

Zhang JJH, Lin L, Kwan L, et al. Immunotherapy utilization patterns in metastatic bladder cancer: assessing insurance status as a modifiable factor associated with failure to receive novel therapies. Presented at SUO 2023. Nov. 28 – Dec. 1, 2023. Washington, DC. Poster 64.

This article originally appeared on Cancer Therapy Advisor