Abstracts from the Abstracts from the Mid-Atlantic Section of the AUA 2021

© The Canadian Journal of Urology TM : International Supplement, October 2021 Moderated Poster Session 4: Kidney/Bladder/Penile/Testicular/ Adrenal Cancer MP4-05 Management of Non-Muscle Invasive Bladder Cancer in a Time of BCG Shortage M. Herzig, R. Chelluri, L. Xia, R. Talwar, A. Wein, T. Guzzo, D. Lee, S. Malkowicz University of Pennsylvania, Philadelphia, PA, USA Introduction andObjective: The current shortage of BCGhasmade allocation of limited resources for the treatment of high-grade non-muscle invasive bladder cancer (NMIBCa) challenging. We evaluated the efficacy of reduced dose (RD) BCG in prolonging disease-free survival and preventing recurrence of NMIBCa in the time of BCG shortage. Methods: Medical records of patients presenting to Penn for management of NMIBCa requiring intravesical BCG between 2015 and 2020 were reviewed. In 2019, we began to provide RD BCG, which was based on the available allotment at the time and thus did not follow any protocol for splitting. Inclusion criteria were tissue diagnosis of NMIBCa treated with TURBT followed by induction BCG. Propensity score matching was used to pair RD patients to full dose (FD) patients based on age, tumor pathology, and initial vs. recurrent disease. Results: 140 patients with high grade NMIBCa were identified. 56 received RD BCG (median dose 123 mg), and the remainder received FD BCG (300 mg). There was no significant difference between groups in age, sex, or prior history of bladder cancer. Disease-free survival at 400 days was 79% in the FD treatment compared to 63% in the RD treatment (p = 0.097). Among patients with recurrent disease after BCG, median disease-free survival was 98 days in RD patients and 208 days in FD patients (p = 0.15). The 400-day disease- free survival was significantly greater among patients who received FD BCG compared to those who received RD BCG (p = 0.044). Conclusions: RD BCG for NMIBCa seems to increase the risk of recurrence compared to FD therapy. These data indicate a need for further investigation to determine the optimal therapy in the setting of the current shortage. Treatment Failure andDisease Progression of Non-Muscle Invasive Bladder Cancer During BCG shortage A. Salib, E. Kloniecke, C. McPartland, T. Chandrasekar, C. Lallas, E. Trabulsi, L. Gomella, A. Calvaresi, J. Izes Thomas Jefferson University Hospital, Philadelphia, PA, USA Introduction and Objective: Intravesical bacillus Calmette Guérin (BCG) instillations play an integral role in the treatment of non-muscle invasive bladder cancer (NMIBC). With the BCG shortage in the U.S., reduced dosing protocols were implemented for induction andmaintenance treatment cycles to meet patients’ needs. In this study, we evaluate the effect of reduced induction BCG dosing on the rate of BCG failure and progression of NMIBC. Methods: Aretrospective chart reviewof the electronicmedical records (EMR) was performed of patients with NMIBC treated at our institution. A total of 300 patients were treated during the period of BCG shortage (1/2017-5/2021). EMR was reviewed for the pathology at diagnosis, size of tumor at initial resection, BCG induction dose, and pathology of recurrence. Patient were assigned risk categories according to the National Comprehensive Cancer Network (NCCN) guidelines into intermediate or high risk. BCG failure was defined as persistence or recurrence of high grade disease after a complete BCG induction course. Progression was defined as development of lamina propria/muscle invasion, or grade upstage. Results: 300 patients were treated with BCG during the period of the study (115 intermediate risk, 185 high risk) (Table 1). The rate of BCG failure in the reduced BCG group was elevated in the intermediate risk (RR 2.29) and total patient population(RR 1.19). The rate of disease progression in the reduced BCG group was elevated in in the intermediate (RR 1.71) , high (RR 1.36) and total groups (RR 1.49). Conclusions: Reduced BCG induction dosing for NMIBC can lead to increased rates of BCG failure and disease progression. Further research is warranted to identify the pathologies at highest risk for recurrence and progression. MP4-04 26