Abstract
PURPOSE: Treatment options for muscle-invasive bladder cancer (MIBC) are generally limited to radical cystectomy (RC) with or without neoadjuvant chemotherapy (NAC), adjuvant chemotherapy (AC), or immunotherapy. To contextualize emerging data on novel therapies, a systematic literature review (SLR) was conducted to evaluate real-world treatment effectiveness and economic and humanistic burden in patients with MIBC who received RC with or without systemic therapy. METHODS: Literature searches identified studies (published January 2018-June 2023) in adult patients with MIBC who received RC in the US, Germany, France, Italy, Spain, and the UK and reported effectiveness, economic burden, or humanistic burden. RESULTS: Of 4192 references identified, 61 reported real-world effectiveness, 12 economic burden, and 5 humanistic burden. No studies on immunotherapy were identified. Reported median overall survival (OS) ranged from 0.7 to 8.3 years with RC alone (n=9), 1.8-7.5 years with NAC+RC (n=6), and 1.5-6.1 years with RC+AC (n=7). Hospital stays for RC had median length of 5-10 days (n=5) and cost >$34,000 in the US. Health-related quality of life (HRQOL) was reported during 1 to 2 years post RC (n=5), but approximately 40% of patients continued to experience high psychosocial distress or low HRQOL. CONCLUSION: Real-world studies have reported modestly longer survival with NAC or AC over RC alone; however, rates of disease recurrence were high and OS remained poor. Given this and the high economic burden for patients with MIBC, more effective therapies are needed.