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

Steinberg, Ryan L.; Thomas, Lewis J.; Brooks, Nathan; Mott, Sarah L.; Vitale, Andrew; Crump, Trafford; Rao, Mounica Y.; Daniels, Marcus J.; Wang, Jonathan; Nagaraju, Supriya; DeWolf, William C.; Lamm, Donald L.; Kates, Max; Hyndman, M. Eric; Kamat, Ashish M.; Bivalacqua, Trinity J.; Nepple, Kenneth G.; O’Donnell, Michael A.

doi:10.1097/ju.0000000000000688

Cited by 113 publications

(86 citation statements)

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“…Gemcitabine was administered in combination with other drugs, like everolimus or docetaxel, in patients after BCG failure 20 . Steinberg et al investigated 276 BCG failure patients who received intravesical gemcitabine plus docetaxel 21 . They reported 1 and 2‐year recurrence‐free survival (RFS) of 60% and 46% with only 10 patients (10/276, 3.6%) who had disease progression.…”

Section: Discussionmentioning

confidence: 99%

Intravesical gemcitabine as bladder‐preserving treatment for BCG unresponsive non‐muscle‐invasive bladder cancer. Results from a single‐arm, open‐label study

et al. 2020

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Background There is an unmet alternative medical therapy for BCG unresponsive patients. Objective To report efficacy of intravesical gemcitabine in NMIBC patients, who failed a previous course of BCG, or intolerant, and unwilling to undergo radical cystectomy (RC). Material and methods This is an open‐label, single‐arm study, which enrolled patients showing a failure or were intolerant to BCG and unwilling to undergo the RC. Intravesical gemcitabine was administered once a week for six consecutive weeks and once a month for 12 months. The primary outcome was DFS defined as the lack of a tumor on cystoscopy and negative urine cytology. Secondary endpoint was safety defined according a grading of side effects. OS, PFS, and DFS were described with Kaplan–Meier method at 12 and 24 months. Results and limitations Overall 36 patients were enrolled. The median follow‐up was 27 months. The DFS was 68.75% at the end of induction phase and 44.44% and 31.66% at 12 and 24 months of, respectively. The PFS was 43.75%. The OS and CSS were 77.9% (95% CI 58.78%‐88.92%) and 80.68% (95% CI 61.49%‐90.96%), respectively. There was no life threatening event or treatment‐related death (grade 4 or 5). The most common mild and moderate adverse events reported were urinary symptoms (LUTS) and fatigue (G1‐G2). Conclusion Patients who presented an unresponsive‐BCG recurrent NMIBC and unwilling to receive a RC, could benefit from intravesical gemcitabine as salvage organ‐sparing treatment.

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Section: Discussionmentioning

confidence: 99%

Intravesical gemcitabine as bladder‐preserving treatment for BCG unresponsive non‐muscle‐invasive bladder cancer. Results from a single‐arm, open‐label study

et al. 2020

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“…-Sequential gemcitabine and docetaxel Intravesical gemcitabine and docetaxel therapy seems to be a promising option. A recent retrospective multiinstitution evaluation has concluded that it is well tolerated and effective, providing a durable response in patients with recurrent NMIBC after BCG therapy [25]. The 2-year recurrence-free survival rate was 46%, and high-grade recurrence-free survival rate was 52%.…”

Section: What Are the Non-extirpative Treatment Options?mentioning

confidence: 99%

BCG-unresponsive high-grade non-muscle invasive bladder cancer: what does the practicing urologist need to know?

2021

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Purpose Bacille Calmette-Guérin (BCG) is a well-established treatment for preventing or delaying tumour recurrence following high-grade nonmuscle invasive bladder cancer (NMIBC) resection. However, many patients will experience recurrence or progression during or following BCG. This scenario has been one of the most challenging in urologic oncology for several decades since BCG implementation. Finally, significant progress has occurred lately. The aim of this review was to summarize for the practising urologist the current treatment options available in 2020 or expected to be ready for routine use in the near future for patients with high-risk NMIBC who experience BCG failure. Methods Narrative review using data through the end of 2020. Results First, the definition of BCG unresponsive disease which is critical in counseling and managing patients has finally reached a consensus. Second, some promising options other than radical cystectomy are finally available and many other should be in a near future. The options can be categorized as chemotherapy, device-assisted therapy, check-point inhibitors, new intravesical and systemic agents and sequential combinations of these newer modalities with conventional therapy. Conclusions Considering the options that are currently under scrutiny, many of which in phase III trials, clinicians should have at their disposal several new treatment options in the next five years.

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“…The results showed that patients with NMIBC benefit from intravesical therapy in terms of oncological outcomes. 15 , 16 , 17 However, poor absorption of drug in tumor tissue due to its non-cancer-specific characteristic and related adverse effects (AEs) reduce the efficacy and safety of intravesical chemotherapy. 18 Comparatively, bacillus Calmette-Guérin (BCG) immunotherapy has more AEs than does chemotherapy, and even some patients may not respond to this therapy.…”

Section: Main Textmentioning

confidence: 99%

Endoscopic Molecular Imaging plus Photoimmunotherapy: A New Strategy for Monitoring and Treatment of Bladder Cancer

Yang

Liu

Yang

2020

Molecular Therapy - Oncolytics

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Due to the high recurrence and progression rate of non-muscle invasive bladder cancer after transurethral resection of bladder tumor, some new optical imaging technologies have arisen as auxiliary imaging modes for white light cystoscopy to improve the detection rate of small or occult tumor lesions, such as photodynamic diagnosis, narrow-band imaging, and molecular imaging. White light cystoscopy is inadequate and imperfect for bladder cancer detection, and thus residual tumors or coexisting flat malignant lesions, especially carcinoma in situ , would be ignored during conventional resection. The bladder, a hollow organ with high compliance, provides an ideal closed operation darkroom for endoscopic molecular imaging free from interference of external light sources. Also, intravesical instillation of a molecular fluorescent tracer is simple and convenient before surgery through the urethra. Molecular fluorescent tracer has high sensitivity and specificity to tumor cells, and its mediated molecular imaging allows small or occult tumor lesion detection while minimizing false-positive results. Meanwhile, endoscopic molecular imaging provides a real-time and dynamic image during surgery, which helps urologists to perform high-quality and complete tumor resection through accurate judgment of tumor boundaries and depth of invasion. Photoimmunotherapy is a novel molecular targeted therapeutic pattern of photodynamic therapy that kills malignant cells selectively and minimizes the cytotoxicity to normal tissues. The combination of endoscopic molecular imaging and photoimmunotherapy used in initial treatment may avoid the need of repeat transurethral resection in strictly selected patients and improve oncological outcomes such as recurrence-free survival and overall survival after operation.

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

Cited by 113 publications

References 0 publications

Intravesical gemcitabine as bladder‐preserving treatment for BCG unresponsive non‐muscle‐invasive bladder cancer. Results from a single‐arm, open‐label study

Intravesical gemcitabine as bladder‐preserving treatment for BCG unresponsive non‐muscle‐invasive bladder cancer. Results from a single‐arm, open‐label study

BCG-unresponsive high-grade non-muscle invasive bladder cancer: what does the practicing urologist need to know?

Endoscopic Molecular Imaging plus Photoimmunotherapy: A New Strategy for Monitoring and Treatment of Bladder Cancer

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