The Efficacy of Sequential Gemcitabine and Docetaxel in Intermediate-Risk Non Muscle Invasive Bladder Cancer - Expert Commentary
The retrospective study included 182 patients, 82 of whom had received Gem/Doce and 100 of whom had received BCG. The median age in the cohort was 68 years. The median follow-up was 48.6 months, with 37.9% of patients experiencing recurrence, 7.7% experiencing any progression, and 2.2% experiencing progression to metastasis or muscle-invasive bladder cancer. Only 2.2% of patients subsequently underwent radical cystectomy, and 22% died during follow-up, although only three deaths (1.7%) were related to bladder cancer. Before induction, patients in the BCG cohort were less likely to have recurrent disease (54% versus 84%, p < 0.001), tumor size greater than or equal to 3 cm (46% versus 28%, p = 0.044), and prior adjuvant intravesical treatment (17% versus 52%, p < 0.001). In contrast, patients in the BCG cohort were more likely to have undergone blue light cystoscopy (73% versus 67%, p = 0.016) and a single instillation of postoperative intravesical chemotherapy (73% versus 39%, p < 0.001). Induction treatment was well-tolerated among all patients. Recurrence rates were similar in both BCG and Gem/Doce groups (p = 0.8). Progression and subsequent radical cystectomy rates were low in both groups.
The findings from this study show that the efficacy of sequential Gem/Doce treatment in intermediate-risk NMIBC patients is comparable to that of BCG. Nevertheless, there were certain variations in treatment among patients across institutions, including the timing of BCG administration. Importantly, during periods of BCG shortage, some patients in the BCG group received one-third of the dose for induction and maintenance. A subset of these patients also received intravesical interferon a-2b. These limitations can be overcome in subsequent prospective studies that are more controlled and consistent in treatment variables.
Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine
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