149P - A need for clear definitions and improved management for BCG-unresponsive tumors in Asia-Pacific

Background

Clinical practice guidelines use different terminologies related to BCG-unresponsive non-muscle invasive bladder cancer (NMIBC) and recommend different treatment approaches. We examined the level of understanding of the terminologies and clinical management related to BCG-unresponsive NMIBC in Asia-Pacific.

Methods

This is a mixed methods study involving 2 parts: 1) a survey with 32 urologists and 8 medical oncologists (MOs) and 2) in-depth interviews with 23 urologists and 3 MOs. All clinicians had ≥8 years of experience managing NMIBC across Australia, Hong Kong, Japan, South Korea, Singapore, and Taiwan. Data from Part 1 were analysed descriptively. We used content and thematic analyses for Part 2.

Results

In part 1, 37% of clinicians defined BCG-unresponsive as BCG-refractory, BCG-relapse and BCG-resistant. Around 50% of clinicians selected radical cystectomy as preferred treatment for BCG-unresponsive patients with the remaining participants selecting bladder-sparing treatment. The most frequently used bladder-sparing treatment was BCG-retreatment (33%). In part 2, we found that 35%, 85% and 35% of the clinicians, respectively, used the terms BCG-unresponsive, BCG-refractory and BCG-relapse in clinical practice but with no consistent interpretation of these terms. When compared with the EAU definitions, less than 60% of clinicians appropriately classified tumor characteristics that are persistent or recurrent after adequate BCG. Clinicians reasoned that BCG re-treatment is still provided to BCG-unresponsive patients due to the lack of effective and low-cost bladder-sparing treatment.

Conclusions

The terminologies related to BCG-unresponsive NMIBC are ambiguous and do not work well in clinical practice. Clearer definition of and more effective bladder-sparing treatments for BCG-unresponsive NMIBC are needed.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

IQVIA Asia Solutions Pte Ltd.

Funding

MSD International GmBH (Singapore Branch).

Disclosure

L.S. Lee: Financial Interests, Personal, Funding: Merck Sharp & Dohme LLC; Financial Interests, Personal, Advisory Board: MSD, AstraZeneca, Bayer, Astellas, Janssen; Financial Interests, Personal, Research Grant: Janssen; Financial Interests, Personal, Invited Speaker: AstraZeneca, MSD, Bayer, Janssen. R. Kanesvaran: Financial Interests, Institutional, Invited Speaker: Astellas, Johnson and Johnson, Ipsen, Amgen, BMS, MSD, Novartis, AstraZeneca, Sanofi; Financial Interests, Institutional, Advisory Board: Johnson and Johnson, Pfizer, Ipsen, Amgen, BMS, MSD, Bayer, AstraZeneca, Ferring; Financial Interests, Institutional, Research Grant: Sanofi, Eisai, Johnson and Johnson; Non-Financial Interests, Personal, Leadership Role, Past President: Singapore Society of Oncology; Non-Financial Interests, Personal, Leadership Role, President: SIOG; Non-Financial Interests, Personal, Leadership Role, Vice Chairman: Singapore Cancer Society; Non-Financial Interests, Personal, Leadership Role, Medical Advisory Board Member: International Kidney Cancer Coalition. E. Kikuchi: Financial Interests, Personal and Institutional, Research Grant: Nippon Kayaku; Financial Interests, Personal and Institutional, Invited Speaker: Chugai, Nippon Kayaku, Janssen; Financial Interests, Personal, Advisory Board: MSD. H. Kitamura: Financial Interests, Personal, Research Grant: AstraZeneca, Bristol Myers Squibb, MSD; Financial Interests, Personal, Invited Speaker: Astellas, AstraZeneca, MSD, Sanofi, Takeda, Bristol Myers Squibb, Merck Biopharma, Janssen; Financial Interests, Personal, Advisory Board: MSD, Janssen. J.H. Ku: Financial Interests, Personal, Advisory Board: MSD. T. Lin: Financial Interests, Personal and Institutional, Other, Honoraria for presentations: Astellas, Ferring pharmaceuticals, Janssen, Bayer, AstraZeneca; Non-Financial Interests, Personal and Institutional, Member, Urological oncology committee: Taiwan Urological Association; Non-Financial Interests, Personal and Institutional, Product Samples, Docetaxel/cabazitaxel compounds: Sanofi; Financial Interests, Personal, Advisory Board: MSD. H. Nishiyama: Financial Interests, Personal, Research Grant: Astellas, Ono Pharmaceutical, Takeda Pharmaceutical; Financial Interests, Personal, Invited Speaker: MSD, Chugai Pharmaceutical, Astellas. A.C.F. Ng: Financial Interests, Personal, Advisory Board: MSD, Newlife Medical Limited, Nonagen, Jiangsu Hengrui Medicine; Financial Interests, Personal, Advisory Role: Cornerstone Medical, Agilis; Financial Interests, Personal, Invited Speaker: Boston Scientfic, Olympus, Ipsen, Janssen, Bayer. J. Ng: Financial Interests, Personal, Full or part-time Employment: IQVIA; Financial Interests, Institutional, Sponsor/Funding, Corporate-sponsored research: MSD. D.M.C. Poon, H.K. Seo, Y. Tsai: Financial Interests, Personal, Advisory Board: MSD. R.R. Shamaileh, C. Spiteri: Financial Interests, Personal, Full or part-time Employment: MSD. E.M. Tan: Financial Interests, Personal, Full or part-time Employment: IQVIA; Financial Interests, Institutional, Sponsor/Funding, Corporate-sponsored research: MSD. B. Tran: Financial Interests, Personal, Research Grant: MSD; Financial Interests, Personal, Research Grant, Individual honoraria: Bristol Myers Squibb ; Financial Interests, Personal, Research Grant, Individual consulting/ advisory role: Ipsen; Financial Interests, Personal and Institutional, Research Grant, Individual honoraria: Astellas Pharma, Janssen-Cilag, Amgen, Pfizer, Bayer; Financial Interests, Institutional, Research Grant: Genentech, AstraZeneca; Financial Interests, Personal, Other, Individual honoraria: Sanofi, Tolmar; Financial Interests, Personal, Advisory Role: Novartis, Roche Molecular Diagnostics.