Multi-Institution Evaluation of Sequential Gemcitabine and Docetaxel as Rescue Therapy for Nonmuscle Invasive Bladder Cancer

No AccessJournal of UrologyAdult Urology1 May 2020Multi-Institution Evaluation of Sequential Gemcitabine and Docetaxel as Rescue Therapy for Nonmuscle Invasive Bladder CancerThis article is commented on by the following:Editorial Comment Ryan L. Steinberg, Lewis J. Thomas, Nathan Brooks, Sarah L. Mott, Andrew Vitale, Trafford Crump, Mounica Y. Rao, Marcus J. Daniels, Jonathan Wang, Supriya Nagaraju, William C. DeWolf, Donald L. Lamm, Max Kates, M. Eric Hyndman, Ashish M. Kamat, Trinity J. Bivalacqua, Kenneth G. Nepple, and Michael A. O’Donnell Ryan L. SteinbergRyan L. Steinberg Department of Urology, University of Texas Southwestern, Dallas, Texas More articles by this author , Lewis J. ThomasLewis J. Thomas Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio More articles by this author , Nathan BrooksNathan Brooks MD Anderson Cancer Center, Houston, Texas More articles by this author , Sarah L. MottSarah L. Mott Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa More articles by this author , Andrew VitaleAndrew Vitale Department of Urology, University of Iowa, Iowa City, Iowa More articles by this author , Trafford CrumpTrafford Crump Department of Urology, University of Calgary, Calgary, Alberta, Canada More articles by this author , Mounica Y. RaoMounica Y. Rao University of Arizona School of Medicine, Phoenix, Arizona More articles by this author , Marcus J. DanielsMarcus J. Daniels Department of Urology, Johns Hopkins University, Baltimore, Maryland More articles by this author , Jonathan WangJonathan Wang Beth Israel Deaconess Medical Center, Boston, Massachusetts More articles by this author , Supriya NagarajuSupriya Nagaraju MD Anderson Cancer Center, Houston, Texas More articles by this author , William C. DeWolfWilliam C. DeWolf Beth Israel Deaconess Medical Center, Boston, Massachusetts More articles by this author , Donald L. LammDonald L. Lamm University of Arizona School of Medicine, Phoenix, Arizona BCG Oncology, Phoenix, Arizona More articles by this author , Max KatesMax Kates Department of Urology, Johns Hopkins University, Baltimore, Maryland More articles by this author , M. Eric HyndmanM. Eric Hyndman Department of Urology, University of Calgary, Calgary, Alberta, Canada More articles by this author , Ashish M. KamatAshish M. Kamat MD Anderson Cancer Center, Houston, Texas Financial interest and/or other relationship with Merck, BMS, Arquer, MDxHealth, Photocure, Theralase, Medac, Asieris, Abbott Molecular and US Biotest. More articles by this author , Trinity J. BivalacquaTrinity J. Bivalacqua Department of Urology, Johns Hopkins University, Baltimore, Maryland More articles by this author , Kenneth G. NeppleKenneth G. Nepple Department of Urology, University of Iowa, Iowa City, Iowa Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa More articles by this author , and Michael A. O’DonnellMichael A. O’Donnell †Correspondence: Department of Urology, University of Iowa Hospitals and Clinics, 3 RCP, 200 Hawkins Drive, Iowa City, Iowa 52242 telephone: 319-353-8939; FAX: 319-356-3900; E-mail Address: [email protected] Department of Urology, University of Iowa, Iowa City, Iowa Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa Financial interest and/or other relationship with Abbott Molecular, Photocure, UroGen, Tocogen, Cold Genesis, Medical Enterprises, Fidia Pharmaceuticals, Vaxiion Pharmaceuticals, Ferring Pharmaceuticals, Sesen Bio, Urovant and Theralase. More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000688AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Rescue intravesical therapies for patients with bacillus Calmette-Guérin failure nonmuscle invasive bladder cancer remain a critical focus of ongoing research. Sequential intravesical gemcitabine and docetaxel therapy has shown safety and efficacy in 2 retrospective, single institution cohorts. This doublet has since been adopted as an intravesical salvage option at multiple institutions. We report the results of a multi-institutional evaluation of gemcitabine and docetaxel. Materials and Methods: Each institution retrospectively reviewed all records of patients treated with intravesical gemcitabine and docetaxel for nonmuscle invasive bladder cancer between June 2009 and May 2018. Only patients with recurrent nonmuscle invasive bladder cancer and a history of bacillus Calmette-Guérin treatment were included in the analysis. If patients were disease-free after induction, maintenance was instituted at the treating physician’s discretion. Posttreatment surveillance followed American Urological Association guidelines. Survival analysis was performed using the Kaplan-Meier method and risk factors for treatment failure were assessed with Cox regression models. Results: Overall 276 patients (median age 73 years, median followup 22.9 months) received treatment. Nine patients were unable to tolerate a full induction course. One and 2-year recurrence-free survival rates were 60% and 46%, and high grade recurrence-free survival rates were 65% and 52%, respectively. Ten patients (3.6%) had disease progression on transurethral resection. Forty-three patients (15.6%) went on to cystectomy (median 11.3 months from induction), of whom 11 (4.0%) had progression to muscle invasion. Analysis identified no patient, disease or prior treatment related factors associated with gemcitabine and docetaxel failure. Conclusions: Intravesical gemcitabine and docetaxel therapy is well tolerated and effective, providing a durable response in patients with recurrent nonmuscle invasive bladder cancer after bacillus Calmette-Guérin therapy. Further prospective study is warranted. References 1. : Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO guideline. J Urol 2016; 196: 1021. Link, Google Scholar 2. : Clarification of bladder cancer disease states following treatment of patients with intravesical BCG. Bladder Cancer 2015; 1: 29. Google Scholar 3. : Definitions, end points, and clinical trial designs for non-muscle-invasive bladder cancer: recommendations from the International Bladder Cancer Group. 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No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of UrologyJan 27, 2020, 12:00:00 AMEditorial Comment Volume 203Issue 5May 2020Page: 902-909Supplementary Materials Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordsgemcitabinedocetaxeladministrationintravesicalurinary bladder neoplasmssalvage therapyMetricsAuthor Information Ryan L. Steinberg Department of Urology, University of Texas Southwestern, Dallas, Texas More articles by this author Lewis J. Thomas Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio More articles by this author Nathan Brooks MD Anderson Cancer Center, Houston, Texas More articles by this author Sarah L. Mott Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa More articles by this author Andrew Vitale Department of Urology, University of Iowa, Iowa City, Iowa More articles by this author Trafford Crump Department of Urology, University of Calgary, Calgary, Alberta, Canada More articles by this author Mounica Y. Rao University of Arizona School of Medicine, Phoenix, Arizona More articles by this author Marcus J. Daniels Department of Urology, Johns Hopkins University, Baltimore, Maryland More articles by this author Jonathan Wang Beth Israel Deaconess Medical Center, Boston, Massachusetts More articles by this author Supriya Nagaraju MD Anderson Cancer Center, Houston, Texas More articles by this author William C. DeWolf Beth Israel Deaconess Medical Center, Boston, Massachusetts More articles by this author Donald L. Lamm University of Arizona School of Medicine, Phoenix, Arizona BCG Oncology, Phoenix, Arizona More articles by this author Max Kates Department of Urology, Johns Hopkins University, Baltimore, Maryland More articles by this author M. Eric Hyndman Department of Urology, University of Calgary, Calgary, Alberta, Canada More articles by this author Ashish M. Kamat MD Anderson Cancer Center, Houston, Texas Financial interest and/or other relationship with Merck, BMS, Arquer, MDxHealth, Photocure, Theralase, Medac, Asieris, Abbott Molecular and US Biotest. More articles by this author Trinity J. Bivalacqua Department of Urology, Johns Hopkins University, Baltimore, Maryland More articles by this author Kenneth G. Nepple Department of Urology, University of Iowa, Iowa City, Iowa Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa More articles by this author Michael A. O’Donnell Department of Urology, University of Iowa, Iowa City, Iowa Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa †Correspondence: Department of Urology, University of Iowa Hospitals and Clinics, 3 RCP, 200 Hawkins Drive, Iowa City, Iowa 52242 telephone: 319-353-8939; FAX: 319-356-3900; E-mail Address: [email protected] Financial interest and/or other relationship with Abbott Molecular, Photocure, UroGen, Tocogen, Cold Genesis, Medical Enterprises, Fidia Pharmaceuticals, Vaxiion Pharmaceuticals, Ferring Pharmaceuticals, Sesen Bio, Urovant and Theralase. More articles by this author Expand All Supported by the John & Carol Walter Family Foundation. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Advertisement PDF DownloadLoading ...