Abstract
PD41-09 SEQUENTIAL ENDOLUMINAL GEMCITABINE AND DOCETAXEL VERSUS BACILLUS CALMETTE-GUÉRIN FOR THE TREATMENT OF HIGH-GRADE UPPER TRACT UROTHELIAL CARCINOMA
The Journal of urology, Vol.211(5S)
05/2024
DOI: 10.1097/01.JU.0001008568.76803.f1.09
Abstract
INTRODUCTION AND OBJECTIVE:
BCG is the only recommended endoluminal treatment option for high-grade (HG) upper tract urothelial carcinoma (UTUC). Gemcitabine/Docetaxel (Gem/Doce) has shown promising efficacy as a treatment for HG UTUC, though a comparison to BCG is lacking. We report the outcomes of patients treated with endoluminal Gem/Doce versus BCG for non-invasive HG UTUC.
METHODS:
A retrospective review of patients treated with Gem/Doce versus BCG for clinically non-invasive HG UTUC was performed. Treatment was instilled via nephrostomy or retrograde ureteral catheter. Induction instillations were performed weekly for 6 weeks. If disease free, maintenance therapy for Gem/Doce was monthly for 6 months and a single 3 week mini-cycle for BCG. Recurrence was defined as biopsy-proven disease or HG cytology. Survival was estimated with the Kaplan-Meier method.
RESULTS:
The final cohort included 59 patients with 71 treated upper tract units; 36 received BCG and 35 received Gem/Doce. Median follow-up was 62 months in the BCG group and 29 months in the Gem/Doce group. Indication for treatment included a positive HG cytology in 78% and 89% of the BCG and Gem/Doce groups, respectively; the remaining patients in each group presented with pathologically-confirmed HG disease. The 2-year estimates for recurrence-free and nephroureterectomy-free survival were 57% and 87% for the BCG group and 56% and 100% for the Gem/Doce group, respectively (Table 1). Upon multivariable analysis, treatment with Gem/Doce was not associated with an increased risk of recurrence versus BCG (HR 0.78, 95%CI 0.33-1.85; p=0.57). In total, 19% of patients receiving BCG and 15% of patients receiving Gem/Doce experienced a grade 3+ adverse event. The development of any symptoms was not statistically different between treatment groups (p=0.28). There were two deaths recorded during the study period, one in each treatment group.
CONCLUSIONS:
Endoluminal Gem/Doce and BCG have comparable effectiveness and similar rates of adverse events in patients with HG-UTUC. Our results support the use of Gem/Doce as an alternative treatment to BCG in patients with HG-UTUC. Further prospective evaluation is warranted.
Details
- Title: Subtitle
- PD41-09 SEQUENTIAL ENDOLUMINAL GEMCITABINE AND DOCETAXEL VERSUS BACILLUS CALMETTE-GUÉRIN FOR THE TREATMENT OF HIGH-GRADE UPPER TRACT UROTHELIAL CARCINOMA
- Creators
- Ian M. McElreeSarah L. MottHelen Y. HouganVignesh T. PackiamMichael A. O'DonnellRyan L. Steinberg
- Resource Type
- Abstract
- Publication Details
- The Journal of urology, Vol.211(5S)
- DOI
- 10.1097/01.JU.0001008568.76803.f1.09
- ISSN
- 0022-5347
- eISSN
- 1527-3792
- Language
- English
- Date published
- 05/2024
- Academic Unit
- Urology
- Record Identifier
- 9984649050902771
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