Controversies in terminology associated with management of BCG‐unresponsive NMIBC in Asia‐Pacific

Abstract

ObjectivesExamine the understanding of terminologies and management patterns of bacillus Calmette‐Guérin (BCG)‐unresponsive nonmuscle invasive bladder cancer (NMIBC) in six territories in Asia‐Pacific.MethodsThis 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.ResultsIn 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.ConclusionsOur 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.