{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T01:18:15Z","timestamp":1747185495750,"version":"3.40.5"},"reference-count":22,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T00:00:00Z","timestamp":1696464000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Urology"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Examine the understanding of terminologies and management patterns of bacillus Calmette\u2010Gu\u00e9rin (BCG)\u2010unresponsive nonmuscle invasive bladder cancer (NMIBC) in six territories in Asia\u2010Pacific.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study involved two phases: (1) a survey with 32 urologists and 7 medical oncologists (MOs) and (2) a factorial experiment and in\u2010depth interviews with 23 urologists and 2 MOs. All clinicians had \u22658\u2009years' experience managing NMIBC patients in Australia, Hong Kong, Japan, South Korea, Singapore, and Taiwan. Data from Phase 1 were summarized using descriptive statistics; content and thematic analyses applied in Phase 2.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In phase 1, 35% of clinicians defined BCG\u2010unresponsive as BCG\u2010refractory, \u2010relapse and \u2010resistant, 6% defined it as BCG\u2010refractory and \u2010relapse; 22% classified BCG\u2010failure as BCG\u2010refractory, \u2010relapse, \u2010resistant, and when muscle\u2010invasive bladder cancer is detected. If eligible and willing, 50% (interquartile range [IQR], 50%\u201380%) of BCG\u2010unresponsive patients would undergo radical cystectomy (RC), and 50% (IQR 20%\u201350%) of RC\u2010eligible patients would receive bladder\u2010sparing treatment or surveillance. In phase 2, we found that 32%, 88%, and 48% of clinicians, respectively, used \u201cBCG\u2010unresponsive,\u201d \u201cBCG\u2010refractory,\u201d and \u201cBCG\u2010relapse\u201d in clinical practice but with no consistent interpretation of the terms. Compared with EAU definitions, 8%\u201360% of clinicians appropriately classified 9 tumor types that are persistent or recurrent after adequate BCG. Fifty percent of clinicians mentioned a lack of bladder\u2010preserving treatment that outperforms RC in quality of life as a reason to retreat BCG\u2010unresponsive patients with BCG.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our study revealed varied understanding and application of BCG\u2010unresponsive terminologies in practice. There is a need for a uniform and simple definition of BCG\u2010unresponsive disease in Asia\u2010Pacific.<\/jats:p><\/jats:sec>","DOI":"10.1111\/iju.15298","type":"journal-article","created":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T20:05:55Z","timestamp":1696536355000},"page":"32-38","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Controversies in terminology associated with management of <scp>BCG<\/scp>\u2010unresponsive <scp>NMIBC<\/scp> in Asia\u2010Pacific"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1624-6676","authenticated-orcid":false,"given":"Eiji","family":"Kikuchi","sequence":"first","affiliation":[{"name":"Department of Urology St. Marianna University School of Medicine  Kawasaki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1723-9646","authenticated-orcid":false,"given":"Chi\u2010Fai","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Surgery The Chinese University of Hong Kong  Hong Kong Hong\u00a0Kong"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Kitamura","sequence":"additional","affiliation":[{"name":"Department of Urology University of Toyama  Toyoma Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ja Hyeon","family":"Ku","sequence":"additional","affiliation":[{"name":"Department of Urology Seoul National University  Seoul South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8208-0635","authenticated-orcid":false,"given":"Lui Shiong","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Urology Seng Kang General Hospital  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tzu\u2010Ping","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Urology Taipei Veterans General Hospital  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junice Yi Siu","family":"Ng","sequence":"additional","affiliation":[{"name":"Health Economics and Outcomes Research IQVIA Asia\u2010Pacific  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroyuki","family":"Nishiyama","sequence":"additional","affiliation":[{"name":"Department of Urology University of Tsukuba  Tsukuba Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darren Ming\u2010Chun","family":"Poon","sequence":"additional","affiliation":[{"name":"Comprehensive Oncology Center Hong Kong Sanatorium &amp; Hospital  Hong Kong Hong Kong"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ravindran","family":"Kanesvaran","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology National Cancer Centre Singapore  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ho Kyung","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Urology National Cancer Center  Goyang\u2010si South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmel","family":"Spiteri","sequence":"additional","affiliation":[{"name":"Market Access Asia Pacific MSD Macquarie Park, NSW  Macquarie Park Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1418-8529","authenticated-orcid":false,"given":"Ee Min","family":"Tan","sequence":"additional","affiliation":[{"name":"Health Economics and Outcomes Research IQVIA Asia\u2010Pacific  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuh\u2010Shyan","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Urology National Cheng Kung University Hospital  Tainan Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ben","family":"Tran","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Peter MacCallum Cancer Centre  Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,10,5]]},"reference":[{"volume-title":"Lyon","year":"2020","author":"WHO","key":"e_1_2_12_2_1"},{"issue":"1","key":"e_1_2_12_3_1","article-title":"Non muscle invasive bladder cancer treatment","volume":"1","author":"Cavaliere C","year":"2014","journal-title":"World Cancer Res J"},{"doi-asserted-by":"publisher","key":"e_1_2_12_4_1","DOI":"10.1007\/s11934-016-0625-z"},{"unstructured":"US Food and Drug Administration.BCG\u2010unresponsive nonmuscle invasive bladder cancer: developing drugs and biologics for treatment guidance for industry [Internet]. Center for Drug Evaluation and Research2018. Available from:https:\/\/www.fda.gov\/media\/101468\/download#:~:text=Patients%20with%20BCG%2Dunresponsive%20NMIBC with%20CIS%2C%20or%20CIS%20alone","key":"e_1_2_12_5_1"},{"doi-asserted-by":"publisher","key":"e_1_2_12_6_1","DOI":"10.1016\/j.eururo.2021.08.010"},{"doi-asserted-by":"publisher","key":"e_1_2_12_7_1","DOI":"10.1111\/iju.14210"},{"doi-asserted-by":"publisher","key":"e_1_2_12_8_1","DOI":"10.1038\/nrurol.2017.16"},{"unstructured":"Defining BCG\u2010Unresponsive and The Pathway to Clinical Trials in Treating NMIBC \u2010 Ashish Kamat [Internet]. [cited 2022 Aug 20]. 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