US Clinical Practice Patterns of Intravesical Chemotherapy for Bacillus Calmette-Guérin–Unresponsive and Bacillus Calmette-Guérin–Exposed Nonmuscle-Invasive Bladder Cancer

Abstract

Introduction:The goal of this survey was to evaluate the treatment and practice pattern of patients with high-grade papillary Ta, T1 nonmuscle-invasive bladder cancer (NMIBC), and carcinoma in situ (CIS) in bacillus Calmette-Guérin (BCG)eunresponsive (with adequate BCG exposure ¼ adequate BCG) and those with less than adequate BCG exposure (BCG-exposed).Methods: An internet-based survey with a target duration of 5 minutes was sent to US urologists who manage patients with NMIBC. Respondents were recruited from the Sesen Bio target list based upon BCG utilization.Results: In 2022, 100 urologists who manage patients with papillary tumors and 159 urologists who manage patients with CIS tumors filled out the survey. Most (78%) were community-based urologists. Study respondents managed an average of 33 (range: 6-158) CIS patients and 44 (range: 10-200) high-grade patients with papillary disease (without CIS) over the past 6 months. Approximately 70% of physicians identified either gemcitabine (w40%) or mitomycin C (w30%) as the most often used intravesical chemotherapies for BCG unresponsive and BCG exposed groups. Most physicians reported the use of gemcitabine 2 g or mitomycin C 40 mg in a specific regimen for induction (once a week  6 weeks) and maintenance (once a month  12 months). Responses were consistent across groups of BCG therapy (adequate vs BCG-exposed). Physicians were slightly more likely to use a maintenance regimen for the adequate BCG patient. Conclusions:The most common treatments received by patients with BCG-unresponsive and BCG-exposed NMIBC were intravesical chemotherapy (single-agent gemcitabine or mitomycin C), regardless of whether CIS or papillary disease was present.

Reply by Authors

“…In a survey conducted among urologic oncologists attending the 2022 Society of Urologic Oncology meeting, roughly 70% reported using Gem/Doce as their preferred agent for BCG-unresponsive cases. 4 In contrast, only 10% of mostly community-based urologists in the current survey reported using Gem/Doce. The source of this discrepancy may well be multifactorial but unfamiliarity with Gem/Doce and its advantages over single agents likely played a role, as well as logistical issues of increased treatment time imposed by sequenced Gem/Doce.…”

Treatment Modalities for Non-Muscle Invasive Bladder Cancer: An Updated Review

“…A study of United States practice patterns showed that only 25% of surveyed urologists would consider radical cystectomy for BCG-unresponsive high-grade papillary disease. Meanwhile, more than half regularly utilized intravesical chemotherapy for these patients [58]. This has spurred the use of novel combinations of existing intravesical therapies, intravesical gene therapies, intravenous immunotherapy, and novel methods of drug delivery in BCG-unresponsive NMIBC.…”

Reply by Authors

“…2 In another survey administered to Arab urologists on the same topic, 30% of respondents were using intravesical chemotherapy for these patients, while only 12% were using SDCs. 3 Data from Europe showed that 50% of urologists may use intravesical chemotherapy (most commonly mitomycin C) for BCG failure. 4 The reason for the disparity in the treatment plan could be complex, but practical concerns arising from the logistical requirements to establish an SDC clinic also probably had an impact, as did the lack of knowledge about SDC and its benefits.…”