Combination intravesical chemotherapy for non-muscle invasive bladder cancer (NMIBC) as first-line or rescue therapy: where do we stand Now?

The combination of intravesical gemcitabine (Gem) with docetaxel (Doce) or with mitomycin C (MMC) has been used in the primary setting as an alternative to Bacillus Calmette-Guerin (BCG) to treat high-risk (HR) and intermediate-risk (IR) non-muscle invasive bladder cancer (NMIBC), as well in the rescue setting for patients in whom BCG has failed.

Efficacy and safety of Gem/Doce and Gem/MMC to treat NMIBC in BCG-naïve and failure settings.

In the BCG-naïve setting, Gem/Doce was the primary alternative combination therapy reported, with a weighted mean 12- and 24-month recurrence-free survival (RFS) of 79% and 77% for HR disease and 84% and 76% for IR disease, respectively. In the HR BCG-failure setting, the weighted mean 12- and 24-month RFS was 60% and 42% for Gem/Doce and 63% and 40% for Gem/MMC. While patients without BCG exposure and papillary disease only benefit the most from Gem/Doce, there is also reasonable efficacy in BCG refractory disease and CIS. Combination therapy is well-tolerated, with grade III toxicity reported in less than 1% of patients. Unlike single agent chemotherapy, intravesical Gem/Doce is considered effective and safe regardless of risk-stratification.

Expert opinion on pharmacotherapy. 2024 Jan 24 [Epub ahead of print]

Mohamad Abou Chakra, Vignesh T Packiam, Igor Duquesne, Michael Peyromaure, Ian M McElree, Michael A O'Donnell

Department of Urology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA., Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA., Department of Urology, Cochin Hospital, Paris, France., Carver College of Medicine, University of Iowa, Iowa City, IA, USA.