Uitkomsten in de dagelijkse praktijk van eerstelijnschemotherapie voor niet-resectabel stadium III en IV urotheelcarcinoom van de blaas

Abstract

The aim of this study was to evaluate the disparity between the efficacy observed in clinical trials and effectiveness in real-world practice (efficacy-effectiveness gap (EE gap)) in palliative first-line (1L) chemotherapy treatment (CTx) for urothelial carcinoma of the bladder. From seven Dutch teaching hospitals, all patients diagnosed with unresectable stage III (cT2-4aN1-3M0) and IV (cT4b and/or cM1) disease, who received 1L-CTx between 2008 and 2016, were captured. Median overall survival (mOS) of gemcitabine + cisplatin (GemCis)-patients was 10.4 months (95%-CI 7.9–13.0), which was shorter compared to clinical trial findings (range mOS: 12.7–14.3 months) despite comparable clinical characteristics. An EE gap seems present. The mOS of gemcitabine + carboplatin (GemCarbo)-patients was 9.3 months (95%-CI 7.5–11.1). GemCarbo patients had worse prognostic characteristics (higher age, impaired renal function and worse performance status (all p-values < 0.001)) compared to GemCis patients, but survival was not statistically significant different in a multivariable regression analysis (HR 0.90 (95%-CI 0.55–1.47), p-value = 0.674).