https://doi.org/10.4081/aiua.2024.12244

Patterns of treatment of high-risk BCG-unresponsive non-muscle invasive bladder cancer (NMIBC) patients among Arab urologists

Vol. 96 No. 1 (2024)
Submitted: December 30, 2023
Accepted: January 17, 2024
Published: March 19, 2024
Non-muscle invasive bladder cancer, BCG unresponsive, practice pattern, Arab urologists, BCG shortage
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Authors

Mohamad Moussa
https://orcid.org/0000-0001-8571-2768
Department of Urology, Lebanese University, Beirut, Lebanon.
Mohamad Abou Chakra
mabouchakra@uiowa.edu
Department of Urology, Lebanese University, Beirut , United States.
Neal D. Shore
https://orcid.org/0000-0001-5767-0548
Carolina Urologic Research Center, Myrtle Beach, SC, United States.
Athanasios Papatsoris
https://orcid.org/0000-0003-2277-1175
Department of Urology, Lebanese University, Beirut, Lebanon.
Yasser Farahat
Urology Department, Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates.
Michael A. O’Donnell
https://orcid.org/0000-0001-7202-6427
Department of Urology, University of Iowa, Iowa City, IA, United States.

Purpose: To understand the treatment plans suggested for BCG-unresponsive non-muscle invasive disease (NMIBC) patients in the Arab countries and therapeutic decisions applied for BCG-naive patients during BCG shortage time.
Methods: A 10-minute online survey was distributed through the Arab Association of Urology (AAU) office to urologists in the Arab countries who treat patients with NMIBC.
Results: One hundred six urologists responded to the survey. The majority of urologists had treated, in the past 6 months, > 10 patients with NMIBC who were considered BCG-unresponsive (55% of respondents). Radical cystectomy (RC) was the most popular treatment option (recommended by 50%) for these patients. This was followed by intravesical chemotherapy (30%), repeat BCG therapy (12%), resection with ongoing surveillance (8%). Clinical trials and intravenous checkpoint inhibitors were never selected. The most preferred intravesical chemotherapy was by ranking: 60% gemcitabine, 19% mitomycin C, 8% docetaxel, 8% gemcitabine/docetaxel, 4% sequential gemcitabine/mitomycin C, and 1% valrubicin. The use of intravesical chemotherapy appears limited by Arab urologists due to concerns regarding clinical efficacy (fear of progression) and the lack of clear recommendations by urology societies. Given the BCG shortage, which may vary per Arab country, Arab urologists have adjusted by prioritizing BCG for T1 and carcinoma in situ (CIS) patients over Ta, adapting intravesical chemotherapy, and reducing the dose/strength of BCG administered. Most physicians report an eagerness to utilize novel therapies to address the BCG deficit, especially to try intravesical chemotherapy.
Conclusions: Even though Arab urologists are in the majority of cases selecting RC for BCG-unresponsive cases, one-third of them are most recently initiating intravesical chemotherapy as an alternative option. To further assist Arab urologists in the appropriate selection of BCG unresponsive high risk NMIBC patient treatments, enhanced education and pathway protocols are needed.

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Mohamad Moussa, Department of Urology, Lebanese University, Beirut

President of the Arab Association of Urology (AAU), Dubai, UAE

Mohamad Abou Chakra, Department of Urology, Lebanese University, Beirut

Department of Urology, University of Iowa, Iowa City, IA, USA

Athanasios Papatsoris, Department of Urology, Lebanese University, Beirut

2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Greece

Yasser Farahat, Urology Department, Sheikh Khalifa General Hospital, Umm Al Quwain

Secretary General of the Arab Association of Urology (AAU), Dubai, UAE

How to Cite

Moussa, M., Abou Chakra, M., Shore, N. D., Papatsoris, A., Farahat, Y., & O’Donnell, M. A. (2024). Patterns of treatment of high-risk BCG-unresponsive non-muscle invasive bladder cancer (NMIBC) patients among Arab urologists. Archivio Italiano Di Urologia E Andrologia, 96(1). https://doi.org/10.4081/aiua.2024.12244
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