Global real-world patients characteristics, treatment patterns, and impact of BCG shortage in patients with high-risk non-muscle invasive bladder cancer.
Notice bibliographique
Résumé
717 Background: Global guidelines recommend that High Risk Non-Muscle Invasive Bladder Cancer (HR NMIBC) patients (pts) receive 1-3 years of Bacillus Calmette-Guérin (BCG) treatment (Tx). This global real-world study aimed to understand pt characteristics, Tx patterns and impact of the BCG shortage in pts with HR NMIBC. Methods: Physicians across EU5 (n=244), the US (n=55), Japan (n=44) and Canada (n=21) were recruited to the Adelphi HR NMIBC Disease Specific Programme: a cross-sectional survey with retrospective data collection extracted from medical record data for their next eight pts with HR NMIBC consecutively consulting with their physician. Tx patterns and characteristics were analysed descriptively. Data was collected from June to December 2023. Results: 364 physicians (55% urologists; 45% medical oncologists) provided data for 1930 pts with an initial diagnosis (IDx) of HR NMIBC. At IDx 73% presented with high grade T1 tumors, 21% had carcinoma in-situ, and 37% had multifocal tumors. The median time between IDx and data collection was 613 days. Tx patterns are described in the table. Of the 1395 pts who received intravesical therapy after IDx, 462 (33%) received induction Tx only, and 875 (63%) received induction followed by maintenance Tx. BCG was most commonly used induction Tx (28%), whilst 5% received intravesical chemo, similarly 56% received BCG maintenance Tx and 7% received chemo. Of those who completed BCG maintenance Tx (n=269) the median (IQR) duration was 336 (180-382) days. Physician reported BCG shortage affected 8% of HR NMIBC pts: 41% received fewer instillations, 37% received lower dosages, and 33% used different strains. Among the 29% of HR NMIBC pts who had ≥1 recurrence the median (IQR) time from IDx to 1 st recurrence was 426 (224-580) days. After 1 st recurrence, 57 pts received partial or radical cystectomies. Physicians surveyed stated that a median 20% of their overall NMIBC caseload were BCG unresponsive and 50% were BCG naïve. 45% of physicians reported having been affected by BCG shortage, ranging from 23% (Japan) to 71% (Canada), 61% reserved BCG for HR pts and 46% used intravesical chemotherapy as an alternative. Conclusions: BCG remains the most frequently prescribed Tx for HR NMIBC pts even though there have been shortage issues and many pts do not receive BCG maintenance. New Tx options that could safely reduce the amount of BCG administered without compromising pts’ outcomes are needed. Tx patterns of pts with HR NMIBC. Tx received After IDx n=1930, n (%) After 1st recurrence n=551, n (%) After 2nd recurrence n=130, n (%) TURBT + intravesical Tx 1209 (63) 194 (35) 40 (31) Other surgery + intravesical Tx 14 (1) 11 (2) 0 (0) Intravesical Tx only 172 (9) 31 (6) 10 (8) TURBT only 327 (17) 162 (29) 43 (33) Other surgery only 13 (1) 9 (2) 3 (2) Radical cystectomy only 0 (0) 44 (8) 6 (4) Other drug Tx ± surgery 88 (4) 41 (7) 9 (7) No Tx 107 (5) 59 (11) 19 (15)
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».