医学
多西紫杉醇
吉西他滨
膀胱癌
内科学
肿瘤科
回顾性队列研究
外科
比例危险模型
化疗
无进展生存期
癌症
泌尿科
膀胱切除术
作者
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,Michael A. O’Donnell
标识
DOI:10.1097/ju.0000000000000688
摘要
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.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.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.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.
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