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Objective: To report on the surgical safety and quality of pelvic lymph node dissection (PLND) in patients treated with radical cystectomy (RC) and PLND for muscle‐invasive bladder cancer (MIBC) after neoadjuvant chemo‐immunotherapy. Patients and Methods: The Swiss Group for Clinical Cancer Research (SAKK) 06/17 was an open‐label single‐arm phase II trial including 61 cisplatin‐fit patients with clinical stage (c)T2–T4a cN0–1 operable urothelial MIBC or upper urinary tract cancer. Patients received neoadjuvant cisplatin/gemcitabine and durvalumab followed by surgery. Prospective quality assessment of surgeries was performed via central review of intraoperative photographs. Postoperative complications were assessed using the Clavien–Dindo Classification. Data were analysed descriptively. Results: A total of 50 patients received RC and PLND. All patients received neoadjuvant chemo‐immunotherapy. The median (interquartile range) number of lymph nodes removed was 29 (23–38). No intraoperative complications were registered. Grade ≥III postoperative complications were reported in 12 patients (24%). Complete nodal dissection (100%) was performed at the level of the obturator fossa (bilaterally) and of the left external iliac region; in 49 patients (98%) at the internal iliac region and at the right external iliac region; in 39 (78%) and 38 (76%) patients at the right and left presacral level, respectively. Conclusion: This study supports the surgical safety of RC and PLND following neoadjuvant chemo‐immunotherapy in patients with MIBC. The extent and completeness of protocol‐defined PLND varies between patients, highlighting the need to communicate and monitor the surgical template. [ABSTRACT FROM AUTHOR]

Prostate cancer (PC) is the most prevalent cancer in men in Switzerland. However, evidence on the real-world health care use of PC patients is scarce. The aim of this study is to describe health care utilization, treatment patterns, and medical costs in PC patients over a period of five years (2014–2018). We used routinely collected longitudinal individual-level claims data from a major provider of mandatory health insurance in Switzerland. Due to the lack of diagnostic coding in the claims data, we identified treated PC patients based on the treatments received. We described health care utilization and treatment pathways for patients with localized and metastatic PC. Costs were calculated from a health care system perspective. A total of 5591 PC patients met the inclusion criteria. Between 2014 and 2018, 1741 patients had outpatient radiotherapy for localized or metastatic PC and 1579 patients underwent radical prostatectomy. 3502 patients had an androgen deprivation therapy (ADT). 9.5% of these patients had a combination therapy with docetaxel, and 11.0% had a combination with abiraterone acetate. Docetaxel was the most commonly used chemotherapy (first-line; n = 413, 78.4% of all patients in chemotherapy). Total medical costs of PC in Switzerland were estimated at CHF 347 m (95% CI 323–372) in 2018. Most PC patients in this study were identified based on the use of ADT. Medical costs of PC in Switzerland amounted to 0.45% of total health care spending in 2018. Treatment of metastatic PC accounted for about two thirds of spending. • Health care spending for prostate cancer in Switzerland was estimated at 347 m Swiss Francs per year. • This is equal to 0.45% of total annual health care spending. • Metastatic prostate cancer patients account for about two thirds of total spending. [ABSTRACT FROM AUTHOR]

Background There is evidence linking metformin to improved prostate cancer (PCa)-related outcomes. Objective To evaluate treatment with metformin in patients with castration-resistant PCa (CRPC) and the effect of the treatment on progression-free survival (PFS) and PSA doubling time (PSA DT). Design, setting, and participants Forty-four men with progressive metastatic CRPC from 10 Swiss centers were included in this single-arm phase 2 trial between December 2010 and December 2011. Intervention Patients received metformin 1000mg twice daily until disease progression. Outcome measurements and statistical analysis The primary end point was the absence of disease progression at 12 wk. Simon two-stage optimal design was applied. With a 5% significance level and 90% power, 44 patients were required to test PFS at 12 wk ≤15% (H0) compared with ≥35% (H1). Results and limitations Thirty-six percent of patients were progression-free at 12 wk, 9.1% were progression-free at 24 wk, and in two patients a confirmed ≥50% prostate-specific antigen (PSA) decline was demonstrated. In 23 patients (52.3%) we observed a prolongation of PSA DT after starting metformin. The homeostatic model assessment index fell by 26% from baseline to 12 wk, indicating an improvement in insulin sensitivity. There was a significant change in insulin-like growth factor-1 and insulin-like growth factor binding protein 3 from baseline to 12 wk. Sample size and lack of a control arm are the limitations of this trial; analyses are therefore exploratory. Conclusions Treatment with metformin is safe in nondiabetic patients, and it yields objective PSA responses and may induce disease stabilization. The activity of metformin in PCa, along with its low cost, favorable toxicity profile, and positive effect on metabolic parameters, suggests that further investigation of metformin as therapy for patients with PCa is of interest. Patient summary In this trial we assessed the use of the diabetes mellitus drug metformin in patients with advanced prostate cancer. We found disease stabilization and prolongation of prostate-specific antigen doubling time in some patients as well as effects on metabolic parameters. Trial registration This study is registered with ClinicalTrials.gov with the identifier NCT01243385. Previous presentation The study was presented at ESMO 2012 (abstract 1460). [ABSTRACT FROM AUTHOR]