Bacillus Calmette-Guerin (BCG) utilization and treatment (Tx) patterns in Chinese patients (pts) with non-muscle invasive bladder cancer (NMIBC): Results from a national urologist survey.

e16587 Background: China has the highest annual incidence (>85,694 new cases) and mortality (>39,393 deaths) from bladder cancer of any country; NMIBC is the most common subtype and is associated with a high risk of recurrence and progression. While intravesical BCG following transurethral resection (TURBT) is effective for NMIBC, there are limited real-world data on patient characteristics, BCG use and factors informing Tx decisions in China. Methods: We performed a cross-sectional, questionnaire-based survey of 300 urologists with experience of administering BCG for NMIBC from 13 cities and 10 provinces across China. Here, we summarized patient characteristics, urologists’ approach to risk assessment, BCG use and Tx patterns. Net Importance Score (NIS) was defined as the percentage of urologists who stated a factor was important (6–7 on a scale from 0–7) minus those who did not (1–4/7). Results: Pts with NMIBC had a median age of 59.6 years, 73% were male, 33% had a low annual household income (≤100,000 CNY ~13,700 USD), 19% had a family history of cancer and the most common TNM stage was T1 (48%). The most common risk assessments (following the NCCN guidelines) were low- or intermediate-risk (both 35% of pts), followed by high risk (26%) and highest risk (4%). Urologists rated tumor stage and grade as the two most important factors for evaluating pt risk level. For pre-treated pts, the most common prior therapy was TURBT (87.1%). Among newly diagnosed pts and pts with recurrent NMIBC, 24% and 32% received BCG, respectively (overall 27%). BCG was most commonly monotherapy and at a dose of 120mg in both newly diagnosed (98% monotherapy/72% 120mg) and recurrent (96% monotherapy/74% 120mg) settings. Most urologists gave a schedule of induction (85%; BCG weekly, duration 6–8 weeks) followed by intensive Tx (65–69%; BCG Q2W, 6–8 weeks), and then maintenance (54%-68%;monthly; ≤1 year), depending on risk level. Compared with chemotherapy, 88% of responders agreed that BCG was more effective in preventing recurrence. The most important factors for choosing BCG were recurrence frequency and risk level and TNM stage (Table); 89% and 88% of urologists responded that limited BCG supply and pricing were important factors in continuing BCG. Post BCG, the most popular subsequent Tx was radical/partial cystectomy (35%) and intravesical chemotherapy (22%) although 15% of responders indicated they would extend BCG. Conclusions: These descriptive survey data provide important insights into real-world BCG utilization and factors influencing BCG use in NMIBC in China. Table: see text