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


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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