AUA 2019: Is Gemcitabine the New Post-TUR Standard of Care?

Chicago, IL (UroToday.com) At the SUO conference, Dr. Gore discussed gemcitabine as the emerging standard of care for post-transurethral resection instillation. He reviewed a study by Messing et al (PMID 29801011) which showed a reduced risk of recurrence at 4 years compared to placebo (35% versus 45%). When compared to studies by Solsona et al (PMID 10081851) and Sylvester et al (PMID 26091833) which reported 5-year recurrence outcomes of 40% after mitomycin C and 55% after placebo, the gemcitabine findings appear very favorable. The above-mentioned study by Sylvester et al also reported 5-year recurrence rates of 45% after combined therapy and 60% after placebo.

The side-effect profile reported for gemcitabine is favorable as well. A study by Messing et al (29801011) showed a 2.4% risk of Grade 3 adverse events following instillation with gemcitabine. A separate study by Filson et al (PMID 23787296) reported a 5.2% risk of “major complications” after treatment with mitomycin C.

The cost of gemcitabine is significantly lower than that of mitomycin C. At one institution, one instillation of mitomycin C costs $1000 while an instillation of gemcitabine costs $70. The value proposition (Value=Quality/Cost) for gemcitabine is arguably significantly higher. When considering all Medicare patients who receive intravesical therapies, the cost savings are substantial.

Taking into consideration the findings discussed above, gemcitabine appears to be a clinically effective therapy on par with currently used agents, with a favorable side effect profile at significantly reduced costs.

Presented by: John Gore, MD, MS, FACS, Associate Professor Adjunct Associate Professor-Surgery, University of Washington
Written by: Selma Masic, MD, Urologic Oncology Fellow (SUO), Fox Chase Cancer Center, @selmasic at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois

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