A national perspective on the management of high-risk BCG-unresponsive non-muscle-invasive bladder cancer in Romania

Maximilian Buzoianu; Bogdan Adrian Buhas; Mohamad Abou Chakra; Emanuela Ionutas; Mihnea Bogdan Borz; Nicolae Crisan; Michael A. O’Donnell

doi:10.4081/aiua.2025.14596

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A national perspective on the management of high-risk BCG-unresponsive non-muscle-invasive bladder cancer in Romania

Journal article

Open access

Peer reviewed

A national perspective on the management of high-risk BCG-unresponsive non-muscle-invasive bladder cancer in Romania

Maximilian Buzoianu, Bogdan Adrian Buhas, Mohamad Abou Chakra, Emanuela Ionutas, Mihnea Bogdan Borz, Nicolae Crisan and Michael A. O’Donnell

Archivio italiano di urologia, andrologia, Vol.97(4), 14596

12/24/2025

DOI: 10.4081/aiua.2025.14596

PMID: 41496691

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Abstract

Purpose: BCG-unresponsive non-muscle invasive bladder cancer (NMIBC) remains a persistent challenge. This study examines Romanian urologists’ clinical practices, focusing on treatment preferences and awareness of emerging therapies for BCG-unresponsive disease. Methods: A cross-sectional, web-based survey comprising 24 items was distributed to selected urologists who manage NMIBC via professional mailing lists. Data were collected between May 15 and June 30, 2025. Results: Out of 400 invited urologists, 216 completed the survey. Radical cystectomy (RC) was the most preferred treatment for BCG-unresponsive NMIBC, recommended by 67% of respondents, followed by tumor resection with surveillance (15%), repeat BCG instillation (14%), and intravesical chemotherapy (4%). Neither clinical trials nor intravenous checkpoint inhibitors were used. Among those using intravesical chemotherapy, gemcitabine was the most commonly used agent (85%), followed by mitomycin C (5%), gemcitabine/docetaxel (4%), gemcitabine/ mitomycin C (3%), docetaxel (2%), and valrubicin (1%). Oncological safety concerns were the main barrier to adopting bladder-sparing therapies. Awareness of FDA-approved therapies for BCG-unresponsive disease, Nadofaragene firadenovec, Nogapendekin alfa inbakicept-pmln, and Pembrolizumab, was limited; 61% of urologists were unaware of all three, and only 1% had used any. BCG shortages were reported by 93% of respondents at some point, who adapted by reducing doses and prioritizing high-grade T1 and CIS cases. Most recognized intravesical chemotherapy as an alternative and were willing to use it if needed. Conclusions: Though RC remains the predominant approach for BCG-unresponsive cases, over half of urologists’ report using intravesical chemotherapy, reflecting interest in bladder-sparing strategies rather than newly approved FDA agents.

Romania

BCG unresponsive

Non-muscle invasive bladder cancer

Practice pattern

Survey

Urologists

Details

Title: Subtitle: A national perspective on the management of high-risk BCG-unresponsive non-muscle-invasive bladder cancer in Romania
Creators: Maximilian Buzoianu - Iuliu Hațieganu University of Medicine and Pharmacy
Bogdan Adrian Buhas - Spitalul Clinic CF Cluj-Napoca
Mohamad Abou Chakra - University of Iowa Health Care
Emanuela Ionutas - Spitalul Clinic CF Cluj-Napoca
Mihnea Bogdan Borz - Universitatea de Medicină, Farmacie, Științe și Tehnologie „George Emil Palade” din Târgu Mureș
Nicolae Crisan - Spitalul Clinic CF Cluj-Napoca
Michael A. O’Donnell - Department of Urology, University of Iowa Health Care, Iowa City, IA, United States
Resource Type: Journal article
Publication Details: Archivio italiano di urologia, andrologia, Vol.97(4), 14596
DOI: 10.4081/aiua.2025.14596
PMID: 41496691
NLM abbreviation: Arch Ital Urol Androl
ISSN: 1124-3562
eISSN: 2282-4197
Publisher: PAGEPRESS PUBL
Language: English
Date published: 12/24/2025
Academic Unit: Urology
Record Identifier: 9985113254702771

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