Management of high-risk non-muscle invasive bladder cancer: a real-world study in North America, Europe and Japan

INTRODUCTION: Non-muscle-invasive bladder cancer (NMIBC) accounts for approximately 75% of newly diagnosed bladder cancers and is particularly prevalent in men. Guidelines stratify patients into risk categories based on disease characteristics as patients often recur or progress to muscle-invasive disease. Most guidelines recommend transurethral resection of bladder tumor (TURBT) followed by up to 3 years of Bacillus Calmette-Guerin (BCG) therapy for high-risk (HR) patients. For very HR patients or those who recur after BCG, radical cystectomy (RC) is recommended. This study aimed to describe the profile of individuals with HR-NMIBC, alongside treatment patterns and outcomes across Europe, North America, and Japan. METHODS: Data were extracted from the Adelphi Disease Specific Program for 1,864 patients initially diagnosed with HR-NMIBC and 273 with very HR-NMIBC. RESULTS: First-line treatment was mainly intravesical BCG, however, less than half of patients received the guideline recommended maintenance BCG and none received RC. Second-line treatment options were similar to first-line, with RC usage still rare. CONCLUSION: While TURBT+BCG was shown to be the current standard of care, the underutilization of full guideline recommended treatment alongside the relatively high number of recurrences highlights the need for novel therapeutic approaches, either in combination with BCG therapy, or as alternative first-line treatments.