To assess the comparative effectiveness and toxicity of intravesical gemcitabine instillation for non-muscle invasive bladder cancer (NMIBC).
We performed a comprehensive literature search on 11 September 2020. We included RCTs in which participants received intravesical gemcitabine for primary or recurrent NMIBC. Two review authors independently assessed the included studies and extracted data for the primary outcomes (time to recurrence, time to progression, grade III to V adverse events) and the secondary outcomes (time to death from bladder cancer, time to death from any cause, grade I or II adverse events, and disease-specific quality of life). We performed statistical analyses using a random-effects model and rated the certainty of the evidence using GRADE.
We found seven studies with 1,222 participants. Gemcitabine may reduce the risk of recurrence over time, but may have a similar effect on progression and grade III to V adverse events compared to saline. Gemcitabine may reduce recurrence and progression compared to mitomycin. We are uncertain about the effect of gemcitabine on the grade III to V adverse events compared to mitomycin. Gemcitabine may reduce recurrence and progression compared to giving BCG again in recurrent high-risk NMIBC after BCG treatment.
Based on the findings of this review, gemcitabine may have a favorable impact on recurrence and progression-free survival than saline and mitomycin but we are uncertain about how major adverse events compare. The same is true when comparing gemcitabine to BCG in individuals with high-risk diseases who have previously failed BCG.
Investigative and clinical urology. 2021 Nov [Epub]
Mi Ah Han, Philipp Maisch, Jae Hung Jung, Jun Eul Hwang, Vikram Narayan, Anne Cleves, Eu Chang Hwang, Philipp Dahm
Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Korea., Department of Urology, Rechtsder Isar Medical Center, Technical University of Munich, Munich, Germany., Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea., Department of Hematology-Oncology, Chonnam National University Medical School, Gwangju, Korea., Department of Urology, Emory University, Atlanta, GA, USA., Velindre NHS Trust, Cardiff University Library Services, Cardiff, UK., Department of Urology, Chonnam National University Medical School, Gwangju, Korea. ., Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, USA.