Intravesical gemcitabine/docetaxel following complete transurethral resection of bladder tumor in patients with nonmuscle-invasive bladder cancer (NMIBC) not previously treated with bacillus Calmette-Guérin (BCG) shows excellent efficacy and durability, according to study findings presented at the 2022 American Urological Association annual meeting in New Orleans, Louisiana.
Patients had 6-, 12-, and 24-month recurrence-free survival (RFS) rates of 89%, 85%, and 82%, respectively, according to medical student Ian M. McElree and colleagues at the University of Iowa Carver College of Medicine in Iowa City, and colleagues.
BCG is currently recommended as adjuvant therapy following complete transurethral resection of bladder tumor (TURBT) for high-risk NMIBC, but production shortages have precluded BCG use in many urologic practices, according to the authors. In response to the shortage, their institution has been using gemcitabine/docetaxel instead.
McElree and colleagues retrospectively reviewed all patients with BCG-naïve high-risk NMIBC treated with gemcitabine/docetaxel. Patients received 6 weekly intravesical instillations of sequential 1 gram of gemcitabine and 37.5 mg of docetaxel after complete TURBT. RFS was the primary outcome. They defined recurrence as tumor relapse in the bladder or prostatic urethra and progression as an increase in T stage or development of muscle-invasive or metastatic disease.
They included 107 patients in their analysis. They had a median follow-up duration of 15 months. The cohort included 47 patients with carcinoma in situ (CIS), 55 with T1 disease, and 7 with micropapillary variant histology. The investigators observed no difference in RFS in patients with or without CIS. No patients had disease progression or died from bladder cancer. One patient underwent cystectomy due to end-stage lower urinary tract symptoms.
A total of 46 patients reported any symptoms during treatment, including urinary frequency/urgency (36% of patients), hematuria (11%), and dysuria (8%).
McElree IM, Steinberg RL, Martin AC, et al. Sequential intravesical gemcitabine and docetaxel for BCG-naïve high-risk non-muscle invasive bladder cancer. Presented at AUA 2022, May 13-16, 2022, New Orleans, Louisiana. Abstract PD26-03.