Intravesicle gemcitabine in management of BCG refractory superficial TCC of urinary bladder—our experience

Mohanty, N.; Nayak, Rajiba L; Vasudeva, Pawan; Arora, Renu

doi:10.1016/j.urolonc.2007.10.016

Cited by 37 publications

(19 citation statements)

References 16 publications

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“…Therefore, gemcitabine is a strong candidate for intravesical therapy in SBC patients who are refractory to BCG. [10][11][12][13] However, after intravesical administration of high doses (40 mg/ml) of gemcitabine in saline solution, significant systemic absorption can still cause gastrointestinal, bladder, and bone marrow toxicity, which limits its clinical value.…”

Section: Regular Articlementioning

confidence: 99%

Microemulsions for Intravesical Delivery of Gemcitabine

et al. 2010

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The objective of this work was to develop a safe and effective delivery vehicle for topical treatment of gemcitabine. The physicochemical properties, drug release rate, drug level in plasma and bladder, and histological changes of tissue after drug administration were investigated. The electrical conductivity, mean size, and viscosity of drug-loaded microemulsions were 0.8-102.0 mS/cm, 116.8-322.5 nm, and 42.9-105.0 cps؋10 3 , respectively. Gemcitabine loaded microemulsions showed a slower and sustained release. After intravesical administration of aqueous control and microemulsions treated, the drug concentrations in plasma were 15.11 mg/ml and 2.81-12.82 mg/ml, respectively, and the accumulation in bladder were 18.27 mg and 9.12-64.16 mg, respectively. Microemulsions slightly decreased the systemic absorption and significantly enhanced the accumulation in bladder tissue. Moreover, the preliminary toxicity studies revealed no overt adverse histological changes or tissue irritation by the microemulsion application. Therefore, the microemulsions were suggested to be a promising drug carrier for intravesical chemotherapy.

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Section: Regular Articlementioning

confidence: 99%

Microemulsions for Intravesical Delivery of Gemcitabine

et al. 2010

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“…Three initial studies evaluating the use of intravesical gemcitabine in the treatment of BCG refractory NMIBC have had widely variable results [17–19]. RFS rates these studies were 10% at 12 months [18], 60% at 18 months [17], and 75% at 12 months [19]. As the number of patients with high-grade NMIBC and/or carcinoma in situ (CIS) or both increased, the RFS decreased, whether they had received prior treatment or not.…”

Section: Discussionmentioning

confidence: 99%

“…All patients in both the studies by Dalbagni et al [18] and Mohanty et al [17] had previously failed at least 1 prior BCG treatment, unlike the study by Bartoletti et al [19] where 64 of 116 (55%) patients were undergoing treatment for their first occurrence of NMIBC and 70 of 116 (60%) had no prior intravesical treatment. In our study, both the 1-RFS and 2-RFS were 56% for patients who failed 1 prior BCG treatment, and 50% and 32% for those who failed 2 or more BCG treatments, respectively.…”

Section: Discussionmentioning

confidence: 99%

Multi-institutional analysis of sequential intravesical gemcitabine and mitomycin C chemotherapy for non–muscle invasive bladder cancer

Lightfoot

Breyer

Rosevear

et al. 2014

Urologic Oncology: Seminars and Original Investigations

101

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Objective Apart from cystectomy, few treatment options exist for the management of bacillus Calmette-Guerin refractory non–muscle invasive bladder cancer (NMIBC). We report a multi-institutional experience with sequential intravesical combination chemotherapy using gemcitabine and mitomycin C (MMC) for NMIBC in the treatment of high-risk patients. Methods We performed a retrospective review of patients who received 6 weekly treatments with sequential intravesical gemcitabine (1 g) and MMC (40 mg) chemotherapy for NMIBC. Gemcitabine was administered first and retained for 90 minutes and then drained. MMC was then administered directly after and retained for an additional 90 minutes. Forty-seven patients received treatment from 3 academic tertiary referral centers between 2000 and 2010. Results Forty-seven patients (median age 70, range 32–85; 36 males, 11 females) who previously failed a median of 2 intravesical treatments were reviewed. Complete response, 1-year, and 2-year recurrence-free survival rates for all patients were 68%, 48%, and 38%, respectively. Median recurrence-free survival for all patients was 9 months (range 1–80). Fourteen of 47 patients (30%) remained free of recurrence with a median time to follow-up of 26 months (range 6–80 mo). Ten patients required cystectomy. Conclusion Sequential intravesical combination chemotherapy using gemcitabine and MMC appears to be a useful treatment for patients with high-grade NMIBC as well as those with prior bacillus Calmette-Guerin failure. Further prospective studies are warranted.

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“…Patients with NMIBC recurrence after intravesical chemotherapy can benefit from BCG instillations [21, 22]. However, if this treatment fails, the treatment options are restricted and comprise a modified immunotherapy treatment, low-dose BCG plus interferon-alpha [23], chemotherapy with intravesical gemcitabine [24, 25] or docetaxel [26]. Cystectomy, however, remains the standard treatment for high-risk patients whose cancers have been unsuccessful with BCG therapy and/or chemotherapy [27].…”

Section: Treatments For Transitional Cell Carcinomamentioning

confidence: 99%

Oncolytic Viruses in the Treatment of Bladder Cancer

Potts

Hitt

Moore

2012

Advances in Urology

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Bladder carcinoma is the second most common malignancy of the urinary tract. Up to 85% of patients with bladder cancer are diagnosed with a tumor that is limited to the bladder mucosa (Ta, T1, and CIS). These stages are commonly termed as non-muscle-invasive bladder cancer (NMIBC). Although the treatment of NMIBC has greatly improved in recent years, there is a need for additional therapies when patients fail bacillus Calmette-Guérin (BCG) and chemotherapeutic agents. We propose that bladder cancer may be an ideal target for oncolytic viruses engineered to selectively replicate in and lyse tumor cells leaving normal cells unharmed. In support of this hypothesis, here we review current treatment strategies for bladder cancer and their shortcomings, as well as recent advancements in oncolytic viral therapy demonstrating encouraging safety profiles and antitumor activity.

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Intravesicle gemcitabine in management of BCG refractory superficial TCC of urinary bladder—our experience

Cited by 37 publications

References 16 publications

Microemulsions for Intravesical Delivery of Gemcitabine

Microemulsions for Intravesical Delivery of Gemcitabine

Multi-institutional analysis of sequential intravesical gemcitabine and mitomycin C chemotherapy for non–muscle invasive bladder cancer

Oncolytic Viruses in the Treatment of Bladder Cancer

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