Controversies in terminology associated with management of BCG-unresponsive NMIBC in Asia-Pacific
- Author(s)
- Kikuchi, E; Ng, CF; Kitamura, H; Ku, JH; Lee, LS; Lin, TP; Ng, JYS; Nishiyama, H; Poon, DM; Kanesvaran, R; Seo, HK; Spiteri, C; Tan, EM; Tsai, YS; Tran, B;
- Details
- Publication Year 2024-01,Volume 31,Issue #1,Page 32-38
- Journal Title
- International Journal of Urology
- Publication Type
- Research article
- Abstract
- OBJECTIVES: Examine the understanding of terminologies and management patterns of bacillus Calmette-Guérin (BCG)-unresponsive nonmuscle invasive bladder cancer (NMIBC) in six territories in Asia-Pacific. METHODS: This study involved two phases: (1) a survey with 32 urologists and 7 medical oncologists (MOs) and (2) a factorial experiment and in-depth interviews with 23 urologists and 2 MOs. All clinicians had ≥8 years' experience managing NMIBC patients in Australia, Hong Kong, Japan, South Korea, Singapore, and Taiwan. Data from Phase 1 were summarized using descriptive statistics; content and thematic analyses applied in Phase 2. RESULTS: In phase 1, 35% of clinicians defined BCG-unresponsive as BCG-refractory, -relapse and -resistant, 6% defined it as BCG-refractory and -relapse; 22% classified BCG-failure as BCG-refractory, -relapse, -resistant, and when muscle-invasive bladder cancer is detected. If eligible and willing, 50% (interquartile range [IQR], 50%-80%) of BCG-unresponsive patients would undergo radical cystectomy (RC), and 50% (IQR 20%-50%) of RC-eligible patients would receive bladder-sparing treatment or surveillance. In phase 2, we found that 32%, 88%, and 48% of clinicians, respectively, used "BCG-unresponsive," "BCG-refractory," and "BCG-relapse" in clinical practice but with no consistent interpretation of the terms. Compared with EAU definitions, 8%-60% of clinicians appropriately classified 9 tumor types that are persistent or recurrent after adequate BCG. Fifty percent of clinicians mentioned a lack of bladder-preserving treatment that outperforms RC in quality of life as a reason to retreat BCG-unresponsive patients with BCG. CONCLUSIONS: Our study revealed varied understanding and application of BCG-unresponsive terminologies in practice. There is a need for a uniform and simple definition of BCG-unresponsive disease in Asia-Pacific.
- Publisher
- Wiley
- Keywords
- Humans; BCG Vaccine/therapeutic use; Quality of Life; *Non-Muscle Invasive Bladder Neoplasms; *Urinary Bladder Neoplasms/pathology; Neoplasm Invasiveness; Recurrence; Hong Kong; Administration, Intravesical; Adjuvants, Immunologic/therapeutic use; Neoplasm Recurrence, Local/prevention & control/drug therapy; BCG vaccine; neoplasm recurrence; patient care management; practice guidelines as topic; urinary bladder neoplasms
- Department(s)
- Medical Oncology
- Publisher's Version
- https://doi.org/10.1111/iju.15298
- Open Access at Publisher's Site
https://doi.org/10.1111/iju.15298- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2024-02-13 06:51:28
Last Modified: 2024-02-13 06:52:03