Journal article
Long-term follow-up of sequential intravesical gemcitabine and docetaxel salvage therapy for non-muscle invasive bladder cancer
Urologic oncology, Vol.41(3), pp.148.e1-148.e7
03/2023
DOI: 10.1016/j.urolonc.2022.10.030
PMID: 36456454
Abstract
•Long-term outcomes of Gemcitabine/Docetaxel after BCG-failure are not well described.•We retrospectively assessed 97 patients with median follow-up of 49 months.•Five-year high-grade recurrence free survival was 30%.•Five-year cystectomy free and cancer specific survival was 75%and 91%, respectively.•Gemcitabine/docetaxel offers long-term efficacy; prospective trials are warranted.
Intravesical gemcitabine and docetaxel (Gem/Doce) has been established as a safe and efficacious salvage treatment for recurrent NMIBC since 2015. Despite widespread adoption of this regimen, long-term outcomes have not been described. We report our experience with intravesical Gem/Doce following BCG failure in a large cohort of patients with extended follow-up.
We retrospectively identified 97 patients at our institution treated with Gem/Doce for high-risk NMIBC after BCG failure between 2009 and 2017. Patients received six weekly intravesical Gem/Doce instillations. Monthly maintenance for 2 years was initiated if disease free at first follow-up. Outcomes included recurrence-free survival (RFS), high-grade recurrence-free survival (HG-RFS), progression-free survival (PFS), cystectomy-free survival (CFS), cancer-specific survival (CSS), and overall survival (OS). Survival probabilities were estimated using the Kaplan-Meier method.
Median follow-up was 49 months. Median age was 73 years, and 71% of the cohort had CIS containing disease. Thirty five percent of the cohort had BCG-unresponsive disease. Complete response at 3-month surveillance was 74% and median duration of response was 25 months. At 1, 2, and 5 years, HG-RFS was 60%, 50%, and 30%, respectively. HG-RFS was similar among BCG-unresponsive patients and the overall cohort. During follow-up, 20 patients underwent cystectomy and 15 patients experienced disease progression. Five-year PFS, CFS, CSS, and OS were 82%, 75%, 91%, and 64%, respectively.
In this long-term analysis, intravesical Gem/Doce for high-risk NMIBC after BCG failure yielded a 75% 5-year bladder preservation rate and a 91% 5-year cancer-specific survival rate. Further prospective trials are warranted.
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Details
- Title: Subtitle
- Long-term follow-up of sequential intravesical gemcitabine and docetaxel salvage therapy for non-muscle invasive bladder cancer
- Creators
- Phani T. Chevuru - University of IowaIan M. McElree - Carver College of Medicine, University of Iowa, Iowa City, IASarah L. Mott - University of IowaRyan L. Steinberg - University of IowaMichael A. O'Donnell - University of IowaVignesh T. Packiam - Department of Urology, University of Iowa, Iowa City, IA
- Resource Type
- Journal article
- Publication Details
- Urologic oncology, Vol.41(3), pp.148.e1-148.e7
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.urolonc.2022.10.030
- PMID
- 36456454
- ISSN
- 1078-1439
- eISSN
- 1873-2496
- Language
- English
- Electronic publication date
- 11/28/2022
- Date published
- 03/2023
- Academic Unit
- Surgery; Urology
- Record Identifier
- 9984322761802771
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