Dr. Prasad shares the take-home message from the ATLAS study of UGN-102 in LG-IR NMIBC


“I can tell you from a patient standpoint, I think we all agreed across the panel, there's going to be tremendous enthusiasm from patients about a nonsurgical option,” says Sandip M. Prasad, MD, MPhil.

In this interview, Sandip M. Prasad, MD, MPhil, shares the take-home message from the recent Journal of Urology paper, “Treatment of Low-Grade Intermediate-Risk Nonmuscle-Invasive Bladder Cancer with UGN-102 ± Transurethral Resection of Bladder Tumor (TURBT) Compared to TURBT Monotherapy: A Randomized, Controlled, Phase 3 Trial (ATLAS).” Prasad is a urologist with Garden State Urology in Morristown, New Jersey.


What is the take-home message of the study for the practicing urologist?

We had the opportunity to speak with a number of study investigators as well as other experts in bladder cancer who were not part of these studies a few weeks ago as sort of a panel discussion, and we asked, is this something that is paradigm shifting? Is this something that's going to be in the corner and we're going to use only in a really select handful of patients? I can speak to my own feeling, which is, my patients aren't interested in having repeat TURBTs. It's the anesthetic. They're older. Sometimes they live alone, they have to get rides, they have to hold medications and get clearances, we put in catheters, they bleed, sometimes they have to come back to the ER because their catheters won't flush. They really don't relish the idea of TURBT. So I can tell you from a patient standpoint, I think we all agreed across the panel, there's going to be tremendous enthusiasm from patients about a nonsurgical option, which again, makes sense. It's sort of intuitive. If we can give you a 4 out of 5 chance that you're going to have no tumor, we can still go back in and treat that 1 out of 5 with a surgical resection. This is low-grade cancer; this has not metastasized rapidly. And again, it's safe and reasonable to say, if we can treat almost all of you without surgery, we'll handle the one who didn't have a response with surgery. But that's paradigm shifting in and of itself. When we spoke as a group amongst urologists and asked how would urologists feel about this, I think we kind of felt the same way, which is that, this is not replacing all of our procedures. We still have to do cystoscopies to check the bladder. So it's not as though we're replacing something we do. We're just doing it differently. Hopefully, we could just look in, reassure patients we've had a really good outcome, and then look back out so we're not doing fewer cystoscopies, we're just doing fewer resections. And again, the resections are what I think gives complications to patients, and again, leads to a lot of effort because those patients are potentially struggling with catheters, with postoperative bleeding, urinary tract infections, general anesthetic complications, we have to take patients on and off their blood thinners safely. I think most urologists felt that if we can offer a nonsurgical option to patients that obviates many of the things we just talked about, I'm all in. And again, it's still a treatment that we give as urologists. We manage this disease, we give the intravesical instillations, we control the treatment options and the treatment selection for this. So I don't think we're taking autonomy away from urologists, they're still going to have another tool in the toolkit. I can speak for myself personally, that if I have nonsurgical options to offer patients that are safe and effective, I am always going to offer those ahead of surgical options, unless for some reason I'm very worried about the tumor. But for those that I know have low-grade disease, which generally have a very low metastatic potential, it's really about tumor eradication. And for me, numbers like two thirds of patients or four fifths of patients, that's going to completely replace my standard of care approach for a first documented low-grade intermediate-risk patient who needs to come for some sort of tumor treatment. For me, that's going to be an intravesical instillation in my office, where you see a nurse, and I'm going to check your bladder a month later or 2 months later to make sure the treatment worked.

This transcript was edited for clarity.

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