Saudi urologists' treatment pattern for high-risk Bacillus Calmette-Guérin naïve and Bacillus Calmette-Guérin unresponsive nonmuscle invasive bladder cancer.

Abstract

Objective: The objective is to learn how Saudi Arabia's urologists treat patients with Bacillus Calmette-Guérin (BCG)-unresponsive nonmuscle invasive bladder cancer (NMIBC) and their choices in management for BCG-naive patients during the BCG shortage.

Materials and methods: A 10-min web-based survey was sent through the King Saud bin Abdul-Aziz University for Health Sciences' College of Medicine Clinical Affairs to urologists treating NMIBC based on the Saudi Urologic Association Database.

Results: The questionnaire was completed by 19 urologists, most of whom (68%) were self-identified as urologic oncologists. In the 6 months before survey administration, the majority of urologists (67% of those surveyed) had treated over five NMIBC patients who had failed BCG therapy. The preferred course of treatment for these patients was a radical cystectomy, as advised by 79% of the participants. Other preferred options were intravesical chemotherapy (16%) and repeat BCG therapy (5%). Clinical trials were never chosen. Sixty percent gemcitabine (Gem), 20% mitomycin C, 10% docetaxel (Doce), and 10% sequential Gem/Doce were rated as the most preferred intravesical chemotherapy regimens used. Saudi urologists were most reluctant to utilize intravesical chemotherapy because of uncertainty about the treatment's clinical effectiveness (oncological safety) and the absence of specific guidelines from urology societies regarding the use of these drugs. BCG shortages are still a problem in Saudi Arabia, as 79% of respondents reported shortages. Most commonly, during BCG shortages, Saudi urologists rationed BCG to patients with high-risk disease, preferring pT1and/or carcinoma in situ to Ta high grade. The minority (16%) switch to intravesical chemotherapy in these circumstances.

Conclusions: Saudi urologists have begun employing a bladder-sparing strategy, particularly intravesical chemotherapy, for BCG-unresponsive disease. To properly select treatment for this condition, there is an urgent need to implement initiatives to open clinical trials and provide guideline-based protocols to Saudi Arabia and throughout the Arab world.