Recent data presented at the 2025 American Society of Clinical Oncology Genitourinary Cancers Symposium highlights significant challenges in implementing new treatments for metastatic urothelial carcinoma (mUC), despite their proven effectiveness. The findings reveal both economic hurdles and practical implementation barriers facing healthcare systems.
Economic Analysis Shows Cost-Effectiveness Challenges
A comprehensive cost-effectiveness analysis comparing new mUC treatment options has revealed striking differences in economic viability. While enfortumab-vedotin plus pembrolizumab (EV + P) demonstrates superior survival benefits, its high cost poses significant implementation challenges.
The study examined lifetime drug costs across different treatment regimens:
- Standard gemcitabine and cisplatin: $458,006
- Gemcitabine and cisplatin plus nivolumab: $597,802
- Enfortumab-vedotin plus pembrolizumab: $1,228,455
Quality-adjusted life-years (QALYs) analysis showed EV + P achieving 2.31 QALYs compared to 1.71 for gemcitabine and cisplatin plus nivolumab. However, the incremental cost-effectiveness ratios (ICERs) tell a different story, with gemcitabine and cisplatin plus nivolumab showing better economic value at $281,142 versus $700,448 for EV + P.
Implementation Challenges in Clinical Practice
A separate study surveying 60 multidisciplinary oncology team members revealed significant practical challenges in integrating novel therapies into clinical practice. Key findings include:
Healthcare providers reported multiple obstacles:
- 28% struggle with individualizing treatment plans and sequencing
- 24% face difficulties keeping up with clinical evidence
- 14% report challenges in differentiating available immunotherapy options
- 12% struggle with providing patient-centered supportive care
- 10% face challenges in shared decision-making
Biomarker Testing and Treatment Patterns
The survey revealed varying adoption rates for different biomarker tests:
- PD-L1 testing: 82% of providers
- HER2 expression: 63%
- FGFR testing: 62%
- PIK3CA and CDKN2A alterations: Less than 50%
While 62% of healthcare providers reported confidence in applying latest guidelines, only 45% of cisplatin-ineligible patients received FDA-approved first-line immunotherapy combination therapy in the metastatic setting.
Improving Implementation Through Action Plans
Following a networkwide workshop, healthcare teams developed targeted improvement strategies:
- Enhanced multidisciplinary coordination
- Standardized biomarker testing protocols
- Increased education on treatment sequencing guidelines
The implementation of these action plans showed promising results:
- 100% of providers reported improved alignment with evidence-based guidelines
- 71% reported increased provider education on integrating new therapies
- 71% noted improved multidisciplinary collaboration
The findings underscore the complex challenges facing healthcare systems in implementing new mUC treatments, balancing clinical effectiveness with economic considerations while addressing practical implementation barriers.
