In recent years, new clinical trial guidelines from the Food and Drug Administration (FDA) have stimulated the development of new drugs for non-muscle-invasive bladder cancer (NMIBC).

However, input from patients has been lacking – particularly, patients’ perspectives on the toxicity of these drugs in relation to clinical benefits, says medical oncologist Noah Hahn, M.D., Deputy Director of the Greenberg Bladder Cancer Institute.

Hahn recently led a multidisciplinary working group that conducted a nationwide survey on key issues related to treatment for NMIBC. The group investigated differences in responses among 845 patients, caregivers, and health- care providers; this work was supported by the Bladder Cancer Advocacy Network. Hahn presented the investigators’ initial results at the 2021 Genitourinary Cancers Symposium, held virtually in February.

“We observed no significant differences among patients, caregivers, urologists, or oncologists with regard to acceptable rates of any reversible or irreversible toxicities,” Hahn says. “However, oncologists accepted higher rates of urologic toxicities, including burning with urination, urine leakage, and urinary frequency, as well as immune- related side effects such as rash, diabetes, and need for steroids.” Complete response to treatment was consistently ranked lowest in clinical relevance among all respondents, but “freedom from cystectomy (surgical bladder removal) and freedom from progression to muscle-invasive disease consistently ranked highest.”

These survey results “suggest an increased emphasis on bladder preservation and durability of response in future clinical trial design guidelines and when evaluating the merits of new NMIBC therapies.”