First-line immunotherapy and chemotherapy for metastatic urothelial carcinoma (mUC) of the bladder are associated with similar overall survival (OS), according to a recent study.

Using the National Cancer Database (NCDB), Nicholas H. Chakiryan, MD, of the H. Lee Moffitt Cancer Center in Tampa, Florida, and colleagues identified 2796 patients who received either first-line immunotherapy or chemotherapy for mUC of the bladder during 2014 to 2017. From this group, the investigators propensity matched 960 patients (480 in each group).

The median follow-up duration was 9.6 months and 9.8 months in the immunotherapy and chemotherapy groups, respectively. Median OS was 12.9 months in the immunotherapy group and 12.3 months in the chemotherapy group, a difference that was not statistically significant, Dr Chakiryan’s team reported online in Urologic Oncology.

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The median time from diagnosis to initiation of therapy was 43 days and was similar for both groups (42 and 44 days for the immunotherapy and chemotherapy groups, respectively).

“The results of this comparative effectiveness analysis externally validate recently reported clinical trial results demonstrating no significant difference in OS for patients who received first-line immunotherapy-monotherapy vs. first-line multi-agent chemotherapy, in a generalizable cohort of patients encountered in real-world clinical practice,” Dr Chakiryan and colleagues wrote. “Patients encountered in real-world clinical practice tend to be older and less healthy than those enrolled into clinical trials, highlighting the importance of external validation of trial results in more representative patient groups that reflect the broader population of metastatic UC patients.”

The investigators noted that a strength of the NCDB is its generalizability to the larger cancer population because it captures more than 70% of newly diagnosed cancers cases in the United States.

The authors acknowledged limitations to the study and its results, including a short follow-up for the survival analysis and the inherent risk of selection bias in retrospective comparative effectiveness studies. In addition, “the NCDB broadly categories first-line systemic therapies such that the names and number of cycles comprising the regimens are not available,” they noted. “As such, we are unable to tell which patients in the chemotherapy group received cisplatin vs. carboplatin. Likewise, specific information is lacking regarding subsequent lines of therapy beyond the first-line treatment.”


Chakiryan NH, Jiang DD, Gillis KA, et al. Comparative effectiveness analysis of first-line immunotherapy versus chemotherapy in metastatic urothelial carcinoma of the bladder. Urol Oncol. Published online August 20, 2021. doi:10.1016/j.urolonc.2021.07.030