Current clinical practice gaps in the treatment of intermediate‐ and high‐risk non‐muscle‐invasive bladder cancer (NMIBC) with emphasis on the use of bacillus Calmette‐Guérin (BCG): results of an international individual patient data survey (IPDS). (1st March 2013)

• Record Type: Journal Article
• Authors: Witjes, J. Alfred; Palou, Joan; Soloway, Mark; Lamm, Donald; Kamat, Ashish M.; Brausi, Maurizio; Persad, Raj; Buckley, Roger; Colombel, Marc; Böhle, Andreas
• Is Part Of: BJU international. Volume 112:Number 6(2013:Sep.)
• Page Start: 742
• Page End: 750
• Publication Date: 2013-03-01
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12012
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12012-sec-0001" sec-type="section"> <title>Objectives</title> <p> <list id="bju12012-list-0001" list-type="bullet"> <list-item> <p>To examine the management of intermediate‐ and high‐risk non‐muscle‐invasive bladder cancer (NMIBC), particularly with regard to the use of bacillus Calmette‐Guérin (BCG) therapy, in North America and Europe.</p> </list-item> <list-item> <p>To compare NMIBC management practices to European Association of Urology (EAU) and American Urological Association (AUA) guideline recommendations for the management of intermediate‐ and high‐risk NMIBC.</p> </list-item> </list> </p> </sec> <sec id="bju12012-sec-0002" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju12012-list-0002" list-type="bullet"> <list-item> <p>In all, 102 urologists from Europe and North America participated in this retrospective on‐line chart review, which was conducted between 1 April 2011 and 30 April 2012.</p> </list-item> <list-item> <p>Participants selected the charts of the first 10 intermediate‐ (defined as multiple or recurrent low‐grade tumours) or high‐risk (defined as any T1 and/or high‐grade/G3 tumours and/or carcinoma <italic>in situ</italic>) patients who underwent transurethral resection of bladder tumour in 2009.</p> </list-item> <list-item> <p>Physicians retrospectively reviewed the charts and completed an on‐line survey consisting of questions related to diagnosis, planned treatment, treatment status and follow‐up.</p> </list-item> <list-item> <p>In all, 971 patients (197 intermediate‐risk; 774 high‐risk) were included in the analysis; frequency counts and associated percentages were used to analyse treatment variables.</p> </list-item> </list> </p> </sec> <sec id="bju12012-sec-0003" sec-type="section"> <title>Results</title> <p> <list id="bju12012-list-0003" list-type="bullet"> <list-item> <p>In all, 47% of intermediate‐risk patients received EAU or AUA guideline‐recommended intravesical therapy: intravesical chemotherapy, BCG induction therapy or BCG induction plus maintenance.</p> </list-item> <list-item> <p>Of the high‐risk patients, 50% received maintenance BCG as recommended by the EAU and the AUA; although not recommended for high‐risk NMIBC, 12.5% received intravesical chemotherapy.</p> </list-item> <list-item> <p>Of patients prescribed maintenance BCG, 93% were scheduled for at least 1 year of therapy.</p> </list-item> <list-item> <p>Notably, only 15% discontinued BCG maintenance and, of these discontinuations, 65% were due to reasons unrelated to BCG‐associated adverse events.</p> </list-item> </list> </p> </sec> <sec id="bju12012-sec-0004" sec-type="section"> <title>Conclusions</title> <p> <list id="bju12012-list-0004" list-type="bullet"> <list-item> <p>There is significant non‐adherence to EAU and AUA guideline recommendations for BCG use in intermediate‐ and high‐risk NMIBC.</p> </list-item> <list-item> <p>However, most of those patients prescribed BCG maintenance therapy are scheduled for at least 1 year of therapy, as recommended by current guidelines for NMIBC management, and BCG maintenance discontinuation is low.</p> </list-item> </list> </p> </sec> </abstract>