Monthly Maintenance Intravesical Combination Gemcitabine/Docetaxel for Non Muscle-invasive Bladder Cancer - Expert Commentary

Bacillus Calmette-Guerin shortage is a critical access issue for patients with non-muscle-invasive bladder cancer (NMIBC). Defining the efficacy of alternative intravesical treatments is an active area of investigation.

A recent study published by Daniels et al. in Urologic Oncology: Seminars and Original Investigations examined the outcomes of maintenance intravesical chemotherapy with Gemcitabine/Docetaxel (GEM/DOCE) in patients with NMIBC. The researchers included 59 patients diagnosed with NMIBC between 2013 and 2018. Patients initially received six weekly intravesical instillations of GEM/DOCE. Monthly maintenance therapy was given to 41 (69.5%) patients who showed no evidence of disease at the first surveillance. The median follow-up period was 24 months.

The researchers found that DFS was 49% at one year and 24% at two years. Forty-nine patients failed at least one induction therapy before receiving GEM/DOCE. Thirty-one patients failed two or more BCG induction therapies before receiving GEM/DOCE. GEM/DOCE was found to be effective for both therapy-naive and patients who have failed previous intravesical therapies (P = 0.39). Out of the 41 patients who were eligible for maintenance therapy, 24 patients were observed, and 17 patients received monthly maintenance with a median follow up of 26 months. DFS at one year was 42% for observed patients and 81% for monthly maintenance patients (P = 0.04). At two years, DFS was 32% for observed patients and 59% for patients receiving maintenance therapy (P = 0.45).

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine

Reference:

1. Daniels MJ, Barry E, Milbar N, Schoenberg M, Bivalacqua TJ, Sankin A, Kates M. An evaluation of monthly maintenance therapy among patients receiving intravesical combination gemcitabine/docetaxel for nonmuscle-invasive bladder cancer. Urol Oncol. 2019 Aug 28. pii: S1078-1439(19)30299-6. doi: 10.1016/j.urolonc.2019.07.022.

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