Abstract 893: Real-world bladder cancer survival across the immunotherapy era: Persistent age-, stage-, and race-ethnicity disparities demand precision oncology strategies.

Abstract Background: Bladder cancer represents 5% of U.S. malignancies, with 82,000 new cases and 17,000 deaths annually. Most tumors are non-muscle invasive, yet recurrence is common and requires long-term surveillance. Five-year survival is high for non-invasive and localized disease (96% and 70%) but drops sharply for regional (34%) and metastatic stages (5%). Despite advances with platinum regimens and, more recently, immune checkpoint inhibitors (ICIs), mortality gaps persist, especially among older adults, Black patients, and those with advanced diseases. Methods: We assessed relative survival for invasive and in situ bladder cancer using SEER-21 data (2000-2021), stratified by race/ethnicity, age, and SEER summary stage. Hispanic origin followed the NAACCR Hispanic Algorithm; AI/AN estimates were limited to PRCDA regions. Survival from 1-10 years after diagnosis was calculated using expected-survival life tables. Results: Overall five-year survival was 78%. Persistent disparities were noted: • Non-Hispanic White: 79.1%• Hispanic: 74.0% • Asian/Pacific Islander: 77.0% • AI/AN: 70.7% • Non-Hispanic Black: 65.0% Age and stage influenced outcomes, with survival ranging from 86.8% (50 yrs) to 75.3% (≥65 yrs), and from 71.3% (localized) to 7.5% (distant). Since 2016, ICIs—including atezolizumab, pembrolizumab, nivolumab, durvalumab, and avelumab—have improved response durability, achieving complete responses in ∼6% and a median OS of ∼15 months in selected patients. Conclusions: Although immunotherapy has expanded options for metastatic urothelial carcinoma, its real-world impact remains uneven. Survival gains are modest, and demographic inequities persist across age, race/ethnicity, and stage. Black and AI/AN patients continue to face the highest mortality, and older adults—who represent most cases—often benefit less due to cisplatin ineligibility, comorbidities, and variable ICI responsiveness. These patterns show that therapeutic advances alone are insufficient; strategies integrating biomarker-based selection, optimized sequencing, and multimodal approaches are urgently needed. Without targeted action, current progress risks widening long-standing disparities in bladder cancer survival. Impact: Closing these gaps requires precision-guided care and equitable access to emerging therapies to ensure survival gains are shared by all patient groups. Citation Format: Maria Ivette Lopez Martinez, Bharat Peddinani, Aura Calderon, Everardo Cobos, Diane NGUYEN. Real-world bladder cancer survival across the immunotherapy era: Persistent age-, stage-, and race-ethnicity disparities demand precision oncology strategies abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 893.