National Belgian survey on managing non-muscle invasive bladder cancer during Mitomycin and bacillus Calmette-Guerin shortage.

INTRODUCTION

Mitomycin C or bacillus Calmette-Guerin (BCG) intravesical instillations are the more widespread adjuvant treatments following transurethral resection of bladder tumor for intermediate and high-risk non-muscle invasive bladder cancer, but both are regularly in short supply worldwide. This Belgian survey assessed the changes of management during shortage period.

METHODS

On behalf of the two national societies of urology in 2023, an anonymous questionnaire was sent to 340 Belgian urologists exploring modifications treatments' practices in shortage period.

RESULTS

In case of Mitomycin C shortage, treatment shifted to epirubicin for low-risk tumor and to epirubicin (57%) and BCG instillations (40%) for intermediate-risk. In case of BCG shortage, reduced doses were used whether for induction (56% high-risk; 58% carcinoma in situ) or maintenance (69% and 76% respectively). In very high-risk, full doses of BCG were significantly reduced (92% to 54.5%; P<0.001) with maintenance period of 3years but with half (6.1% to 27.3%; P<0.05) or third of doses (0% to 24.2%; P<0.008) respectively. Otherwise, upfront radical cystectomy significantly increased from 9.1% to 33.3% (P=0.035) in this group. Alternatives approaches remained occasional.

CONCLUSION

Management of non-muscle invasive bladder cancer is significantly impacted by the availability of drugs. This survey underlined the discomfort of Belgian urologists in the management of overall NMIBC in periods of shortage MMC and BCG supply and reduced adherence to guidelines could be deleterious on recurrence and progression risks. There is a room for promoting access to clinical trials.