Journal article
Multi-Institution Evaluation of Sequential Intravesical Gemcitabine and Docetaxel in the Treatment of Bacillus Calmette-Guerin Naïve Patients with Non-Muscle Invasive Bladder Cancer
Clinical genitourinary cancer
09/2022
DOI: 10.1016/j.clgc.2022.09.004
Abstract
Introduction
: Single agent intravesical chemotherapy regimens have historically compared unfavorably to Bacillus Calmette-Guerin (BCG) as initial treatment following resection for patients with high-risk non-muscle invasive bladder cancer (NMIBC). However, there have been few reports of multi-agent intravesical chemotherapy regimens in this setting. Our objective is to determine the efficacy of sequential intravesical gemcitabine and docetaxel (Gem/Doce) in BCG naïve patients with NMIBC.
Patients and Methods
: Collaborating institutions retrospectively identified patients with NMIBC who were treated with Gem/Doce between 6/2009 and 5/2018. An sub-cohort of patients without prior BCG and treated with Gem/Doce was identified. Treatment consisted of 6 weekly instillations of gemcitabine (1 gram/50mL) followed immediately by docetaxel (37.5 mg/50mL). Maintenance was utilized at the discretion of the treating physician. Recurrence-free survival (RFS), progression (PFS), and overall survival (OS) were assessed. Treatment tolerance and discontinuation were also evaluated. Statistical analysis was descriptive in nature.
Results
: Sixty-five patients were treated, with median age 75 years and median follow-up of 15.2 months. 77% had high-grade disease and 40% had carcinoma in-situ (CIS). RFS was 82%, 76%, and 66% at 6, 12 and 24 months respectively. Amongst patients with high-grade disease, high-grade RFS was 85%, 78%, and 66% at 6, 12, and 24 months respectively. One patient progressed to muscle-invasive bladder cancer. Limitations include the retrospective study design, small cohort size, and lack of a comparator arm.
Conclusion
: Intravesical Gem/Doce may be an effective treatment for BCG naïve NIMBC and warrants further investigation.
MicroAbstract
: BCG is the gold-standard adjuvant treatment following TURBT for high-risk NMIBC. Unfortunately, ongoing production shortages have diminished BCG availability. In a multi-institutional retrospective cohort of 65 patients, we f 56098[mound sequential intravesical gemcitabine and docetaxel (Gem/Doce) provided significant relief of recurrence (66% RFS at 2-years) and was well-tolerated (97% finished a full induction). Prospective evaluation of Gem/Doce is underway.
Details
- Title: Subtitle
- Multi-Institution Evaluation of Sequential Intravesical Gemcitabine and Docetaxel in the Treatment of Bacillus Calmette-Guerin Naïve Patients with Non-Muscle Invasive Bladder Cancer
- Creators
- Lewis J. Thomas - Washington University in St. LouisRyan L. SteinbergVignesh T. PackiamIan M. McElreeNathan BrooksAndrew VitaleEric HyndmanTrafford CrumpMounica Y. RaoDonald L. LammMarcus J. DanielsMax KatesSupriya NagarajuAshish M. KamatTrinity J. BivalacquaSarah L. MottKenneth G. NeppleMichael A. O'Donnell
- Resource Type
- Journal article
- Publication Details
- Clinical genitourinary cancer
- DOI
- 10.1016/j.clgc.2022.09.004
- ISSN
- 1558-7673
- eISSN
- 1938-0682
- Language
- English
- Electronic publication date
- 09/2022
- Academic Unit
- Urology
- Record Identifier
- 9984353497102771
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