HSD64 Real-world adjuvant nivolumab utilization in surgically treated muscle-invasive bladder cancer patients within U.S. community oncology practice

The ConcertAI Patient360TM Bladder Dataset, derived from electronic medical records, was used to identify adult patients with MIBC (T2-T4aN0M0, T1-T4aN1M0) undergoing radical cystectomy between February 19, 2021 (six-months before nivolumab approval) and October 31, 2023. Patients with a history of other primary cancers, non-bladder systemic antineoplastic therapies, prior partial cystectomy, or neoadjuvant radiation were excluded. Patients were considered to be at high risk of recurrence if they met one of two criteria: a) received neoadjuvant cisplatin-based therapy and pT2-T4a or pN+; or, b) if patient did not receive neoadjuvant cisplatin-based therapy, pT3-4a or pN+. Neoadjuvant and adjuvant treatment utilization was described among all MIBC patients and then further among those with high risk of recurrence following surgery.

A total of 138 eligible patients were identified (median age 69 years; 71% male; 81% White; 82% de novo; 91% urothelial histology). Of these, the majority (72%; 100/138) received neoadjuvant therapy, while 15% (21/138) received adjuvant treatment, with 13% (18/138) receiving adjuvant nivolumab. Further, 13% (18/138) of patients received neoadjuvant and adjuvant treatment. About half of the patients were at high risk of recurrence following surgery (57/108 patients with complete pathologic staging). Of these, 68% (39/57) received neoadjuvant treatment and 28% (16/57) received adjuvant treatment with 26% (15/57) receiving adjuvant nivolumab.

In the era of adjuvant nivolumab, most patients with radically resected MIBC are receiving neoadjuvant treatment. Conversely, adjuvant nivolumab use was limited, even among patients with high risk of recurrence at radical cystectomy.