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Bladder Cancer Overview

Bladder Cancer Prevalence

Diagnosing Bladder Cancer

Types of Bladder Cancer

Unmet Needs in NMIBC

BCG Treatment

Understaging

Inadequate Treatment

Recurrence and Progression

Quality of Life Outcomes

Resources

Assessing the challenges in high-risk NMIBC1

Take a closer look at the standard of care in high-risk NMIBC.

For 30+ years, there has been an established standard of care for high-risk NMIBC1-3

At initial diagnosis, a complete TURBT is performed

6-week induction course of intravesical instillations of single-agent BCG

Maintenance therapy of 3 weekly instillations at months 3, 6, 12, 18, 24, 30, and 36

BCG=bacillus Calmette-Guérin; NMIBC=non–muscle-invasive bladder cancer; TURBT=transurethral resection of bladder tumor.

Review challenges that patients may face.

Understaging

Accurate staging is pivotal in high-risk NMIBC treatment4

In a systemic review of 19 trials,*

10-30%

of patients with NMIBC were initially understaged4,5

*Trials were included when they met the following criteria: at least 75 patients having high-risk NMIBC (according to European Association of Urology [EAU] guidelines: T1G3, multifocal or highly recurrent, CIS), patients were initially treated conservatively (TURBT and intravesical instillations), a median follow-up of at least 48 months, reporting data on progression to MIBC and death resulting from BCa.4

BCa=bladder cancer; CIS=carcinoma in situ; MIBC=muscle-invasive bladder cancer.

Understaging can cause inadequate treatment

INADEQUATE Treatment

Most patients do not receive adequate treatment according to guidelines6

Less than 1/3 of patients are receiving adequate BCG

Real-world evidence shows that 5-year RFS, PFS, and OS rates were lowest when BCG induction/ maintenance schedules were not followed, or when patients did not receive BCG.7

OS=overall survival; PFS=progression-free survival; RFS=recurrence-free survival.

See the potential recurrence and progression risks in high-risk NMIBC.

Recurrence and progression

More patients may experience recurrence and progression than expected1,7

60%

of patients with high-risk NMIBC experienced recurrence 1 year after single-agent BCG treatment.1

~20%

 of patients with high-risk NMIBC may experience disease progression to MIBC within 48 months of diagnosis.1

Continue to learn more about the possible risks of recurrence and progression.

Quality of Life Outcomes

Patients who experience recurrence or progression require additional procedures or treatments that may significantly impact their quality of life1,8

Repeated invasive surveillance cystoscopies and intravesical treatments can be a significant patient burden.8

When a patient reaches the point of cystectomy, it can lead to other poor clinical outcomes, such as8:

30 days post cystectomy

~25%

of patients are readmitted9 

90 days post cystectomy

~60%

of patients experience postoperative complications9

Postoperative complications9

%

Gastrointestinal

29%

Infectious

25%

Wound-related

15%

Genitourinary

11%

 See the mortality risks associated with advanced outcomes.

Delaying progression is critical—5-year relative survival rates decrease by 89% once cancer has metastasized10

5-year relative survival based on clinical stage10*

97%71%39%8%
97%71%39%8%

*In situ=only in originating cells; localized=confined to primary site; regional=spread to regional lymph nodes; distant=cancer has metastasized.10

References: 1. Shore ND, Redorta JP, Robert G, et al. Non-muscle-invasive bladder cancer: an overview of potential new treatment options. Urol Oncol. 2021;39(10):642-663. 2. Holzbeierlein J, Bixler BR, Buckley DI, et al. Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO guideline: 2024 amendment. J Urol. 2024. Published online ahead of print January 24, 2024. doi:10.1097JU.0000000000003846 3. Gontero P, Comperat E, Dominguez Escrig JL, et al. EAU guidelines on non-muscle-invasive bladder cancer (TaT1 and CIS). Presented at the EAU Annual Congress Milan. Milan, Italy; March 10-13, 2023. 4. Van den Bosch S, Witjes JA. Long-term cancer specific survival in patients with high risk non-muscle-invasive bladder cancer and tumor progression: a systematic review. Eur Urol. 2011;60(3):493-500. 5. Naselli A, Hurle R, Stefano P, et al. Role of restaging transurethral resection for T1 non-muscle invasive bladder cancer: a systematic review and meta-analysis. Eur Urol Focus. 2018;(4):558-567. 6. Kumar N, Balaji HP, Emond B, et al. Real-world treatment patterns among patients with non-muscle invasive bladder cancer (NMIBC) treated with intravesical Bacillus Calmette-Guerin (BCG). 2022 ASCO Quality Care Symposium. Accessed November 1, 2023. https://ascopubs.org/doi/10.1200/JCO.2022.40.28_suppl.404 7. Bedke J, Black PC, Szabados B, et al. Optimizing outcomes for high-risk, non-muscle-invasive bladder cancer: the evolving role of PD-(L)1 inhibition. Urol Oncol. 2023;(12):461-475. 8. Jung A, Nielsen ME, Crandell JL, et al. Health-related quality of life among non-muscle-invasive bladder cancer survivors: a population-based study. BJU Int. 2020;125(1):38-48. 9. Lenis AT, Lec PM, Chamie K. Bladder cancer: a review. JAMA. 2020;324(19):1980-1991. 10. National Cancer Institute: Surveillance, Epidemiology, and End Results Program. Cancer stat facts: bladder cancer. Accessed March 15, 2024. https://seer.cancer.gov/statfacts/html/urinb.html

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March 2024

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